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

Abstract

IntroductionApolipoprotein complement is a critical determinant of lipoprotein function and metabolism. The relation between exogenous insulin and apolipoproteins (apos) in newly diagnosed type 1 diabetes mellitus (T1DM) has not yet been studied extensively. The aim of this study was to prospectively observe the changes in serum apos AI (apo AI) and AII (apo AII) in patients with newly diagnosed T1DM and their association with the daily insulin requirement.Material and methodsThirty-four participants of the InLipoDiab1 study aged 26 (IQR: 22–32) were enrolled in this analysis. Apolipoprotein AI and AII concentrations were assessed at diagnosis and at follow-up after 3 weeks, 6 months, and 1 year of insulin treatment. The daily dose of insulin (DDI) was calculated as the amount of short- and long-acting insulin at discharge from the hospital and at follow-up visits.ResultsThe changes in apo AI concentration were observed after 3 weeks of insulin treatment (p = 0.04), with the largest increase between 3 weeks and 6 months of observation (p < 0.001). Apolipoprotein AII level did not change significantly after 3 weeks, while a significant increase was observed between 3 weeks and 6 months of treatment (p < 0.001). The correlations between DDI and apo concentration were not statistically significant.ConclusionsIn the first year of T1DM, there is a significant increase in apos concentration. Due to the significant deviation of apos concentration from accepted norms, changes in the recommendations of lipid control criteria in T1DM may be considered.

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“…Despite the proven effectiveness of HIS combination therapy with ezetimibe and PCSK9 inhibitors, 24% of physicians deescalate the statin dose by adding ezetimibe or PCSK9i [ 45 , 46 ], thereby reducing the expected percentage of patients reaching their risk-stratified goal for LDL-C. Thus, it is critically important to emphasize that while adding ezetimibe or PCSK9i to HIS, the statin dose not be reduced unless the patient is experiencing statin-related side effects [ 47 – 49 ].…”