Elsevier

The Journal of Pediatrics

Volume 162, Issue 1, January 2013, Pages 101-107.e1
The Journal of Pediatrics

Original Article
Glucose Control Predicts 2-Year Change in Lipid Profile in Youth with Type 1 Diabetes

Presented in abstract form at the American Diabetes Association Scientific Session in New Orleans, LA, June 6, 2009.
https://doi.org/10.1016/j.jpeds.2012.06.006Get rights and content

Objective

To test the hypothesis that a change in glycated hemoglobin (A1c) over a follow-up interval of approximately 2 years would be associated with concomitant changes in fasting lipids in individuals with type 1 diabetes (T1D).

Study design

All subjects with T1D diagnosed in 2002-2005 in the SEARCH for Diabetes in Youth study with at least 2 study visits ∼12 and ∼24 months after an initial visit were included (age at initial visit, 10.6 ± 4.1 years; 48% female; diabetes duration, 10 ± 7 months; 76% non-Hispanic white; A1c = 7.7% ± 1.4%). Longitudinal mixed models were fit to examine the relationship between change in A1c and change in lipid levels (total cholesterol [TC], high-density lipoprotein-cholesterol [HDL-c], low-density lipoprotein-cholesterol [LDL-c], log triglycerides [TG], and non–HDL-c) with adjustment for possible confounders.

Results

Change in A1c over time was significantly associated with changes in TC, HDL-c, LDL-c, TG, and non–HDL-c over the range of A1c values. For example, for a person with an A1c of 10% and then a 2% decrease in A1c 2 years later (to 8%), the model predicted concomitant changes in TC (−0.29 mmol/L, −11.4 mg/dL), HDL-c (0.03 mmol/L, 1.3 mg/dL), LDL-c (−0.23 mmol/L, −9.0 mg/dL), and non–HDL-c (−0.32 mmol/L, −12.4 mg/dL) and an 8.5% decrease in TG (mmol/L).

Conclusions

Improved glucose control over a 2-year follow-up was associated with a more favorable lipid profile but may be insufficient to normalize lipids in dyslipidemic T1D youth needing to decrease lipids to goal.

Section snippets

Methods

SEARCH is an ongoing study that began in 2001 to conduct population-based case ascertainment of youth <20 years with diabetes.9 SEARCH has a defined protocol for incident cases to have 12- and 24-month follow-up visits after their initial study visit. This report includes information for the participants in the 2002-2005 incident cohorts and the corresponding 12- and 24-month visits for participants with at least 1 follow-up visit after the initial study visit. The study was reviewed and

Results

The clinical characteristics of 1193 individuals at the initial visit are described in Table I (age = 10.6 ± 4.1 years, 48% female, T1D duration = 10 ± 7 months, 76% NHW, A1c = 7.7% ± 1.4%). Mean and SD for fasting lipid measures at the initial visit were TC 4.17 ± 0.76 mmol/L or 161 ± 29 mg/dL, HDL-c 1.39 ± 0.33 mmol/L or 54 ± 13 mg/dL, LDL-c 2.45 ± 0.63 mmol/L or 95 ± 24 mg/dL, TG [median (Q1, Q3)] 0.62 (0.50, 0.81) mmol/L or 55 (42, 72) mg/dL, and non–HDL-c 2.78 ± 0.69 mmol/L or 108 ± 27

Discussion

We demonstrate that change in glucose control is associated with changes in lipids over a period of ∼2 years in youth with T1D. This relationship remains after controlling for the effects of initial age, race/ethnicity, sex, season of the year, T1D duration, and BMI z score. These data suggest that improvement of glucose control in youth with T1D may have a limited (ie, a decrease of 0.23 mmol/L in LDL-c associated with a decrease in A1c from 10% to 8% over 2 years), though beneficial effect on

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      Concomitant with their relatively good risk factor profile, the discordant High HbA1c – Normal Non-HDLc group also appears to carry some protection against long-term CVD and DKD mortality despite their poor glycemic control. In type 1 diabetes, the association between glycemic control and lipids has been most extensively studied in children and young adults, in an effort to better understand the earlier CVD risk observed in the type 1 diabetes population [1–8]. Our finding that HbA1c is strongly associated with Non-HDLc and triglycerides but not with HDLc over time is consistent with prior longitudinal studies in youth [4–9].

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    The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. D.M. and R.W. received a research grant from Merck for a clinical trial of lipid-lowering medications in youth with type 1 diabetes. The other authors declare no conflicts of interest.

    A list of members of the SEARCH for Diabetes in Youth Study and funding information are available at www.jpeds.com (Appendix).

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