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HbA1c, BMI z score affect LDL, non-HDL cholesterol
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LDL and non-HDL cholesterol are modestly influenced by changes in HbA1c levels and BMI z score in children with type 1 diabetes, and the effects are greater with increasing age, study data show.
Elevations in HbA1c and BMI z score should be addressed as children enter adolescence and adulthood to help improve lipid levels, according to the researchers.
Michelle L. Katz, MD, MPH, of the section on genetics and epidemiology at Joslin Diabetes Center in Boston, and colleagues evaluated data from 572 children (mean age, 12 years; 54% girls) with type 1 diabetes to determine the influence of HbA1c and BMI on LDL, HDL and non-HDL trajectories. Follow-up was conducted for a median of 9.3 years.
Participants underwent a median of seven lipid assessments. At the first observation, mean LDL concentration was 95 mg/dL, mean HDL concentration was 55 mg/dL and mean non-HDL concentration was 115 mg/dL; 41% of participants had LDL concentrations of at least 100 mg/dL; 23% had an HDL concentration of less than 45 mg/dL; 40% had a non-HDL concentration of at least 120 mg/dL. HbA1c level was 8.9% at the initial observation.
At the last observation, mean age of participants was 21.7 years; mean LDL concentration was 98 mg/dL, mean HDL concentration was 60 mg/dL and mean non-HDL concentration was 118 mg/dL; 41% of participants had an LDL concentration of at least 100 mg/dL, 17% had an HDL concentration of less than 45 mg/dL and 40% had a non-HDL concentration of at least 120 mg/dL. HbA1c level was equal to that of the first observation (8.9%). During follow-up, 10% of participants were exposed to lipid-modifying medications or supplements.
LDL levels increased by approximately 2 mg/dL to 6 mg/dL for every 1% increase in HbA1c; increases were greater as participants aged into adulthood. There was a mean increase in LDL of 2.1 mg/dL for every 1 standard deviation increase in BMI z score when participants were aged 10 years and a mean increase of 8.2 mg/dL when participants were aged 19 years. Non-HDL cholesterol levels were similarly affected by HbA1c and BMI z score.
Significant but modest decreases in HDL were associated with BMI z score, and extremely small increases in HDL levels were associated with increases in HbA1c.
“LDL and non-HDL cholesterol levels relate similarly to HbA1c and [BMI z score] in our population of youths and young adults with type 1 diabetes,” the researchers wrote. “Increases in HbA1c levels and [BMI z score] values are associated with modest increases in LDL and non-HDL cholesterol levels. There are greater effects of HbA1c levels and [BMI z score] values on LDL and non-HDL cholesterol levels as subjects age, but the influence of HbA1c level and [BMI z score] values on HDL level are constant as subjects age.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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