Background: Diabetic dyslipidaemia is characterized by high triglycerides (TG), low HDL cholesterol (HDL-C) and the presence of small, dense LDL. The UK National Paediatric Diabetes Audit (NPDA) 2013/14 reported that 16.1% of children and young people (CYP) with type 1 diabetes mellitus (T1DM) have a total cholesterol (TC) of ≥ 5 mmol/l. TG, LDL and TC-HDL-C were not reported in the NPDA. The significantly high prevalence of hypercholesterolemia in CYP with T1DM is concerning.
Objective and hypotheses: To evaluate the factors associated with dyslipidaemia in CYP with T1DM.
Method: We examined TC, LDL, TG, TC/HDL-C ratio, BMI SDS, mean HbA1c over 12 months (mmol/mol), duration of diagnosis, pubertal status and total daily insulin requirement (TDI) in units/kg/day of CYP with T1DM between 2014 and 2015 in four paediatric diabetes centres within the Northwest of England.
Results: There were 371 CYP (201 males); 250 were on multiple daily insulin regimen, 102 on continuous subcutaneous insulin infusion (CSII) and 19 on twice-daily insulin regimen. Mean of variables±S.D. was Age at diagnosis: 7.55±3.9 years; BMI SDS 0.62±1.02; TDI 0.91±0.36; HbA1c 68±17; TC 4.4±0.84 mmol/l; TC/HDL-C ratio 2.94±0.86; LDL 2.18±0.77 mmol/l; TG 1.11±0.73 mmol/l. 93 CYP were prepubertal, 170 pubertal and 107 post-pubertal. There was significant positive correlation between TC and HbA1c (r=0.3, P=0.002) and between TC/HDL-C ratio and HbA1c (P<0.001). Total daily insulin (P<0.001) and duration of diagnosis (P=0.02) were significantly associated with higher TC/HDL-C ratio. Multivariable regression analyses of factors affecting TC, LDL, TG, TC/HDL-C ratio (BMI SDS, pubertal status, HbA1c, duration of diagnosis and TDI) showed that HbA1c was an independent factor affecting TC (P<0.001), TG (P=0.01), LDL (P=0.04) and TC/HDL-C ratio (P<0.001). TDI was also an independent factor affecting LDL (P=0.02) and TC/HDL-C ratio (P=0.005), and BMI SDS was an independent factor affecting TC/HDL-C ratio (P=0.008).
Conclusion: There was a significant relationship between poor glycaemic control and higher TC levels and TC:HDL-C ratio. HbA1c was an independent factor affecting TC, TC:HDL-C, LDL and TG. Poor glycaemic control increases the risk of diabetes dyslipidaemia in CYP with T1DM.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology