ESPE Abstracts (2014) 82 P-D-1-3-85

Algorithm-Based Cholesterol Monitoring in Children with Type 1 Diabetes

K Otfried Schwaba, Juergen Doerferb, Christa Scheidt-Navec, Bärbel-Maria Kurthd, Andreas Hungelee, Nicole Scheuingf, Andreas Krebsg, Axel Dosth, Tilman R Rohreri, Edith Schoberj & Reinhard W Hollk

aUniversity Hospital, Freiburg, Baden-Württemberg, Germany; bUniversity Hospital, Freiburg, Baden-Württemberg, Germany; cRobert-Koch-Institute, Berlin, Germany; dRobert-Koch-Institute, Berlin, Germany; eUniversity Ulm, Ulm, Baden-Württemberg, Germany; fUniversity Ulm, Ulm, Baden-Württemberg, Germany; gUniversity Hospital, Freiburg, Baden-Württemberg, Germany; hUniversity Hospital, Jena, Thuringia, Germany; iSaarland University, Homburg, Saarland, Germany; jUniversity Hospital, Vienna, Austria; kUniversity Ulm, Ulm, Baden-Württemberg, Germany

Background: Lipid profiles of type 1 diabetic children are influenced by age, sex, BMI- and HbA1c-values. There is a discrepancy between increased cholesterol levels and the management required. Thus, 26% of patients have dyslipidemia but only 0.4% of them receive lipid lowering medication.

Objective and hypothesis: To facilitate child-specific and diabetes-related cholesterol control, we developed a monitoring algorithm derived from population-based reference values.

Method: LDL-, non-HDL-, and HDL cholesterol percentile values were calculated for children with type 1 diabetes and non-diabetic peers within algorithm-based categories of sex, age: 1–10 vs >10–<18 years, BMI: <90th vs ≥90th percentile, and HbA1c <6%, 6–<7.5%, 7.5–9%, >9%. Analyses included 26 147 patients sampled from a German/Austrian population-based registry for type 1 diabetes (DPV) and 14 057 non-diabetic peers participating in the national health interview and examination survey for children and adolescents (KiGGS) in Germany.

Results: HDL-C values are almost higher in diabetic children than healthy peers. Very good controlled children with diabetes (HbA1c <7.5%) have a less atherogenic lipid profile compared to healthy peers. However, pubertal, overweight diabetic girls with a poor diabetes control show the most atherogenic lipid profile. HbA1c values influence the lipid profile most markedly, less in prepubertal than in pubertal children.

Conclusion: The population-based algorithmic approach applied to LDL-, non-HDL-, and HDL cholesterol allows referencing diabetic children with regard to their non-diabetic peers and, if necessary, suggesting corrections of glycemic control to optimize long-term cholesterol monitoring. Pubertal overweight girls with a poor diabetes control need the most careful monitoring.