Prevalence of Abnormal Lipid Profiles and the Relationship With the Development of Microalbuminuria in Adolescents With Type 1 Diabetes

Abstract

OBJECTIVE -To explore the prevalence of lipid abnormalities and their relationship with albumin excretion and microalbuminuria in adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS -The study population comprised 895 young subjects with type 1 diabetes (490 males); median age at the baseline assessment was 14.5 years (range 10 -21.1), and median diabetes duration was 4.8 years (0.2-17). A total of 2,194 nonfasting blood samples were collected longitudinally for determination of total cholesterol, LDL cholesterol, HDL cholesterol, TG, and non-HDL cholesterol. Additional annually collected data on anthropometric parameters, A1C, and albumin-to-creatinine ratio (ACR) were available.RESULTS -Total cholesterol, LDL cholesterol, HDL cholesterol, and non-HDL cholesterol were higher in females than in males (all P Ͻ 0.001). A significant proportion of subjects presented sustained lipid abnormalities during follow-up: total cholesterol Ͼ5.2 mmol/l (18.6%), non-HDL cholesterol Ͼ3.4 mmol/l (25.9%), TG Ͼ1.7 mmol/l (20.1%), and LDL cholesterol Ͼ3.4 mmol/l (9.6%). Age and duration were significantly related to all lipid parameters (P Ͻ 0.001); A1C was independently related to all parameters (P Ͻ 0.001) except HDL cholesterol, whereas BMI SD scores were related to all parameters (P Ͻ 0.05) except total cholesterol. Total cholesterol and non-HDL cholesterol were independently related to longitudinal changes in ACR (B coefficient Ϯ SE): 0.03 Ϯ 0.01/1 mmol/l, P ϭ 0.009, and 0.32 Ϯ 0.014/1 mmol/l, P ϭ 0.02, respectively. Overall mean total cholesterol and non-HDL cholesterol were higher in microalbuminuria positive (n ϭ 115) than in normoalbuminuric subjects (n ϭ 780): total cholesterol 4.7 Ϯ 1.2 vs. 4.5 Ϯ 0.8 mmol/l (P ϭ 0.04) and non-HDL cholesterol 3.2 Ϯ 1.2 vs. 2.9 Ϯ 0.8 mmol/l (P ϭ 0.03).CONCLUSIONS -In this longitudinal study of adolescents with type 1 diabetes, sustained lipid abnormalities were related to age, duration, BMI, and A1C. Furthermore, ACR was related to both total cholesterol and non-HDL cholesterol, indicating a potential role in the pathogenesis of diabetic nephropathy.

Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT): Urinary Screening and Baseline Biochemical and Cardiovascular Assessments

“…Previous studies have shown an association between albumin excretion and lipid parameters, including total cholesterol, LDL cholesterol, and non-HDL cholesterol (25,26). We found that levels of non-HDL cholesterol were significantly increased in subjects with higher ACR.…”

The prevalence of dyslipidemia and associated factors in children and adolescents with type 1 diabetes

“…Previous studies have also reported that girls had higher BMI than boys [17,[23][24][25]. Girls reaching puberty earlier than boys may explain the more advanced pubertal stage in the same age group.…”

“…Hypercholesterolemia is reported to be more common among diabetic compared to non-diabetic males [34]. Another study determined that girls had higher lipid levels, among which hypercholesterolemia was the most common, and that age, diabetes duration, increased BMI and A 1C levels were associated with lipid anomalies [24,35]. Polak et al investigated abnormal lipid profiles in children with T1D during puberty and described that cholesterol levels were not associated with metabolic control, while triglyceride levels could have a weak correlation with metabolic control [19].…”

Lipid Disorders in Type 1 Diabetes

“…In a prospective study performed in 895 young subjects with type 1 diabetes, 20.1% had plasma triglycerides above 1.7 mmol/l, 9.6% had LDL-cholesterol above 3.4 mmol/l and 25.9% had non-HDL cholesterol above 3.4 mmol/l (Marcovecchio et al, 2009). It has been shown that abnormal lipid levels, in type 1 diabetes, predict worse cardiovascular outcomes (Soedamah-Muthu et al, 2004).…”

“…It has been shown that abnormal lipid levels, in type 1 diabetes, predict worse cardiovascular outcomes (Soedamah-Muthu et al, 2004). HbA1c has been shown to be independently correlated with LDL-cholesterol, non-HDL cholesterol and triglyceride levels, indicating that these disorders were mostly observed in patients with poor glycemic control (Marcovecchio et al, 2009). In a British follow-up study of 229 children with type 1 diabetes, LDL cholesterol and non-HDL cholesterol values increased with duration of diabetes (Edge et al, 2008).…”