An increase in high‑density lipoprotein cholesterol concentration after initiation of insulin treatment is dose‑dependent in newly diagnosed type 1 diabetes. The results of the InLipoDiab1 study

Abstract

RESEARCH LETTER HDL cholesterol and insulin treatment in type 1 diabetes 69 diagnosed T1D (28 women and 50 men; mean age, 25.7 years [range, 21.6-30.0 years]), who participated in the Insulin Therapy and Lipoproteins Profile in Type 1 Diabetes Study (InLipoDiab1, NCT02 306 005). All patients were treated with intensive insulin therapy from the onset of the disease. The inclusion criteria for the study were as follows: age between 18 and 35 years, newly diagnosed T1D and initiation of insulin therapy, as well as consent for participation in the study. Patients were assessed at the time of diagnosis (the samples collected before administration of insulin) and then at a follow -up visit in an outpatient clinic after 3 months of insulin treatment. The diagnosis of T1D was confirmed by the measurement of disease -specific autoantibodies.Measurements Anthropometric data including body mass index and body weight were assessed. The daily dose of insulin (DDI) was defined as the requirement for insulin per kilogram body weight per day. This amount of insulin was calculated as the sum of units of long-and short--acting insulin. The final DDI at the time of diagnosis (baseline DDI) was established on the last day of hospitalization when glucose levels reached the treatment target and the patient could be discharged home. The DDI after 3 months was calculated at the follow -up visit based on data derived from patients' self -monitoring logs from the last month. The average dose of insulin that has been used by patients over the last 30 days was calculated. The lipid profile including the levels of total cholesterol, HDL-C, and triglycerides was measured with a Cobas 6000 biochemistry analyzer

The Influence of Body Fat and Lean Mass on HbA1c and Lipid Profile in Children and Adolescents with Type 1 Diabetes Mellitus

“…Refs. [ 50 , 53 , 54 , 55 ] demonstrated that Apo AI levels can be significantly augmented in newly diagnosed DM1 subjects during the first twelve months of diagnosis, and the authors suggested that apo levels can work as markers of micro and macrovascular imbalance that are associated with the late DM1 complications.…”

Association between dyslipidemia and antihypertensive and antidiabetic treatments in a China multicenter study

“…[20][21][22] The same indication bias mechanism may also apply for the adverse metabolic profile associated with the use of insulin, because some of the previous studies did show beneficial metabolic effects of insulin on lipid profile, characterized of lower total and LDL cholesterol, lower triglycerides, and higher HDL cholesterol. 23,24 The study results had to be interpreted within the context of several limitations. First, the study had a cross-sectional design and hence does not allow any causal inference.…”

“…Current hypertension guidelines recommend the use of these drugs in patients with diabetes mellitus or the metabolic syndrome 20‐22 . The same indication bias mechanism may also apply for the adverse metabolic profile associated with the use of insulin, because some of the previous studies did show beneficial metabolic effects of insulin on lipid profile, characterized of lower total and LDL cholesterol, lower triglycerides, and higher HDL cholesterol 23,24 …”

Is it time to change the goals of lipid management in type 1 diabetes mellitus? Changes in apolipoprotein levels during the first year of type 1 diabetes mellitus. Prospective InLipoDiab1 study

“…All patients were hospitalized, on average, for 7 days due to newly diagnosed T1DM. The patients were treated with intensive insulin therapy using insulin pens from the moment of diagnosis and underwent the same educational program as we described previously [ 14 ]. The daily dose of insulin (DDI) was defined as the requirement for insulin per kilogram of body weight per day.…”

“…Moreover, there is a lack of data on the relationship between apo abnormalities at the time of T1DM diagnosis and the development of atherosclerotic cardiovascular disease and other complications in the future. Our previous observations showed that the initiation of insulin therapy in patients with newly diagnosed T1DM causes a significant increase in HDL-C level after 3 months of treatment, and this effect is dose-dependent [ 14 ]. Conflicting data exist regarding the level of apo AI in patients with T1DM.…”