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Glycemic control, adiposity independent predictors of dyslipidemia in children with type 1 diabetes
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Approximately one-quarter of children with type 1 diabetes progressed to dyslipidemia or maintained abnormal lipid levels over 7 years, with HbA1c and waist-to-height ratio serving as independent predictors of their status, according to an analysis of the ongoing SEARCH for Diabetes in Youth study.
“Here, we report prospective lipid data in youth with type 1 diabetes over a mean follow-up of 7 years, the longest follow-up published in this population to date,” Amy S. Shah, MD, MS, of the department of pediatrics at Cincinnati Children’s Hospital and the University of Cincinnati, and colleagues wrote. “We show that 19% of the cohort progressed to abnormal non-HDL cholesterol concentrations during this time. Also concerning is that 7% of youth had sustained abnormal non-HDL cholesterol over time, but only 5% had regressed.”
Shah and colleagues analyzed data from 1,478 children with type 1 diabetes who were not on lipid-lowering medications at baseline participating in the SEARCH for Diabetes in Youth study (mean age, 11 years; 50% boys; 77% white). The cohort was followed for a mean of 7.1 years. Researchers defined progression to dyslipidemia as normal lipid concentrations at baseline and abnormal levels at follow-up (non-HDL cholesterol 130 mg/dL or HDL cholesterol < 35 mg/dL). Regression was defined as abnormal lipids at baseline and normal at follow-up. Researchers used logistic regression analysis to assess predictors of progression and regression vs. stable normal levels and stable abnormal levels, respectively. Area under the curve (AUC) for waist-to-height ratio and HbA1c also were included in models.
Within the cohort, 19% progressed to dyslipidemia; 5% regressed; 7% maintained stable but abnormal lipid levels. HDL cholesterol progressed to abnormal levels in 3% of children, regressed in 3% and remained stable but abnormal in 1%.
Compared with children who maintained stable, normal lipid levels during follow-up, those with progressing non-HDL cholesterol levels were more likely to be girls, have a greater BMI z score or waist-to-height ratio, longer disease duration and higher HbA1c (P < .05 for all). Children who maintained stable but abnormal lipid levels had greater adiposity and higher HbA1c vs. children with normal lipid levels (P < .05 for both).
In logistic regression models adjusted for multiple factors, including age, diabetes duration at baseline, race and sex, researchers found that non-HDL cholesterol progression was associated with higher HbA1c AUC and higher waist-to-height ratio AUC. HDL cholesterol progression was associated with male sex and a higher waist-to-height ratio AUC.
“The findings suggest perhaps maintaining normal weight status and good blood glucose control are important in maintaining good cholesterol levels,” Shah told Endocrine Today. “To confirm our findings, it is important for the next studies to evaluate whether loss of central adiposity and maintaining adequate blood glucose control improve lipids in youth with type 1 diabetes.”
The researchers also noted that, although worse glycemic control appears to adversely affect lipid levels, lowering HbA1c through intensive insulin therapy may also negatively affect body weight.
“These results point to a delicate balance between achieving glycemic control and maintaining body weight on lipids that remains to be elucidated,” the wrote. – by Regina Schaffer
Disclosure: The SEARCH for Diabetes in Youth study is funded by the NIH and National Institute of Diabetes and Digestive and Kidney Diseases and supported by the CDC. The researchers report no relevant financial disclosures.
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