Background: Type 1 diabetes (T1D) contributes to altered lipid profiles and increased cardiovascular disease (CVD) risk. Youth with T1D may have subclinical CVD within the first decade of diagnosis.
Objective: To assess risk factors associated with dyslipidemia in young subjects with T1D.
Study Design and Methods: A longitudinal and cross-sectional retrospective cohort study was conducted based on data collected from medical records of T1D patients treated in the National Center for Childhood Diabetes in Israel. Clinical and laboratory parameters including lipid profile [total cholesterol (TC), triglycerides, low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C)] were extracted from patient's computerized medical records. A structured telephone interview was conducted to update the family history for cardio-metabolic diseases (T2D, CVD, hypertension, dyslipidemia). Potential risk factors and confounders for 10-year outcomes of lipid profiles were analyzed by stepwise linear regression models. Potential risk factors included were gender, ethnicity, Tanner stage, BMI-SDS, systolic and diastolic blood pressure (BP), and glycosylated hemoglobin (HbA1c) levels, age at diagnosis and T1D duration, and family history of cardiometabolic diseases.
Results: 170 young subjects with T1D (86 males; mean age 12.2 ± 4.6 years and HbA1c 8.2 ± 1.4% at baseline) were followed from diabetes onset through young adulthood. Significant risk factors for elevated TC: diastolic BP [B(SE)=17.9(6.0), P=.004], HbA1c [B(SE)=6.5(3.0), P=.033], family history of CVD [B(SE)=14.1(6.5), P=.033], female sex [B(SE)=11.4(5.3), P=.036]; elevated LDL-C: diastolic BP [B(SE)=14.3(5.1), P=.007] and family history of CVD [B(SE)=11.5(5.6), P=.044]; elevated triglycerides: HbA1c [B(SE)=16.1(5.5), P=.004] and diastolic BP [B(SE)=23.4(10.9), P=.035]. No predictors were found for low HDL-C levels.
Conclusions: Our findings suggest that elevated lipid levels are associated with glycemic control, diastolic BP, positive family history of CVD, and female sex. Since poor glycemic control and elevated BP aggravate the risk for dyslipidemia, careful surveillance is warranted to prevent and control these modifiable risk factors already from childhood and adolescence. The more prominent clustering of CVD risk factors in poorly controlled T1D patients underscores the importance of a more vigorous intervention in this group.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology