ESPE Abstracts

Background: Cardiovascular risk factors largely determine morbidity and mortality in people with type 1 diabetes (T1D). Hyperlipidemia, especially in pediatric patients, is often undertreated, although it can lead to premature atherosclerotic changes. While non-HDL-C (non-HDL-cholesterol) is an important risk factor for cardiovascular events in patients with diabetes, guidelines only define LDL-C treatment targets. According to current ISPAD guidelines, children with T1D and LDL-C > 130 mg/dl should be treated.

Methods: Analysis from 2010 to 2023 based on the multicenter German Diabetes Prospective Follow-up Registry DPV (311 centers from Germany, Austria, Switzerland and Luxembourg). Inclusion criteria were T1D, age < 18 years, at least 1 total cholesterol (TC) and HDL-C value documented simultaneously. Lipid values determined < 4 weeks after diabetes onset with ketoacidosis were not included in the analysis. Non-HDL-C was calculated as (TC – HDL-C). Since LDL-C and non-HDL-C are strongly correlated, we considered a non-HDL-C >160 mg/dl as pathological based on the treatment threshold of >130 mg/dl for LDL-C. Statistical analysis was performed with SAS 9.4.

Results: 34,682 patients were included (median; Q25/75): age 12.9 years (9.3/15.7), LDL-C 94 mg/dl (78/112.5), non-HDL-C 107 mg/dl (89.3/128), 53% male. Regarding the entire cohort, non-HDL-C was positively correlated to LDL-C (r =0.89), age (r =0.06), migration background (r =0.03), BMI-SDS (r =0.16), HbA1c (r = 0.2), and negatively to male sex (r =-0.13) and diabetes duration (r =-0.04) (all P <0.0001). In the age grou P < 6 years (n = 3,581), there was no significant correlation between non-HDL-C and migration background or BMI-SDS, in the age group 12-18 years (n = 27,243) not for non-HDL-C and age. In total, 8.0% had LDL-C >130 mg/dl, 5.8% non-HDL-C >160 mg/dl (age groups: < 6y: 4.8/5.6%; 6-12y: 6.2/4.5%; 12-18y: 9.9/6.6%). 1% received lipid-lowering therapy (mainly statins). 410 patients had LDL-C < 130 mg/dl, but non-HDL-C > 160 mg/dl. Of these 3.9% were treated with lipid-lowering therapy.

Conclusion: We found a positive correlation of non-HDL-C to female sex and HbA1c, and found higher non-HDL-C values in children with migration background > 6 years. Interestingly correlation to BMI-SDS was only present in children > 6 years. In contrast to other publications, we found a negative correlation with diabetes duration. In total, the vast majority of the cohort is undertreated for hypercholesterolemia. Additionally, 1.1% of the non-treated patients had an LDL < 130 mg/dl, hence no treatment indication, but still an elevated non-HDL-C. In these patients the cardiovascular risk might be underestimated.