Longitudinal Study of Lipoprotein(a) in Peripubertal Children with Insulin‐dependent Diabetes

Abstract

We aimed to examine the longitudinal relationship between lipoprotein(a) and haemoglobin A1c, albumin excretion rate, and puberty in peripubertal children with insulin-dependent diabetes. A total of 114 patients aged 11.5 +/- 3.6 years (mean (SD)) were followed prospectively for 15.2 +/- 2.8 months. Lipoprotein(a), apolipoproteinB-100, haemoglobin A1c, mean overnight albumin excretion rate and Tanner stage were determined at the beginning and end of the study period. Lipoprotein(a) and apolipoproteinB-100 were measured using nephelometry. This method was correlated with radioimmunoassay and there was no significant change in mean bias during the study. Lipoprotein(a) fell significantly over time (214, (152, 276); 160 (84, 236) mg l-1 geometric mean (0.95 confidence intervals), p < 0.001); apolipoproteinB-100 did not change. Lipoprotein(a) and apolipoproteinB-100 did not differ in 233 cross-sectional controls of similar age. The change in lipoprotein(a) did not correlate with a small fall in haemoglobin A1c or with overnight albumin excretion rate, Tanner stage or insulin dose. Separate analysis of male and female patients and prepubertal and pubertal patients continued to show a significant fall in lipoprotein(a) independent of change in haemoglobin A1c or albumin excretion rate. Likewise, 53 patients with a change in haemoglobin A1c of greater than 1%, and 20 patients who progressed from normal albumin excretion rate to albumin excretion rate above the 95th centile, showed no relationship between lipoprotein(a) and haemoglobin A1c or albumin excretion rate. In conclusion, longitudinal changes in lipoprotein(a) do not relate to metabolic control or early changes in albuminuria in young patients with insulin-dependent diabetes.

Contemporary Australian outcomes in childhood and adolescent type 1 diabetes: 10 years post the Diabetes Control and Complications Trial

“…1 The potential impact of the DCCT findings upon Australian diabetes care in childhood and adolescence were foreshadowed in 1995. 2 At this time it was anticipated that an overall improvement in diabetic metabolic control during childhood and adolescence was desirable and indeed possible. This was to be achieved by redefining therapeutic goals and aiming for age-specific HbA1c ranges.…”

“…Arguably, the modern era of diabetes care commenced in 1993 after the publication of the Diabetes Control and Complications Trial (DCCT) results 1 . The potential impact of the DCCT findings upon Australian diabetes care in childhood and adolescence were foreshadowed in 1995 2 . At this time it was anticipated that an overall improvement in diabetic metabolic control during childhood and adolescence was desirable and indeed possible.…”