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Abstract
Background Diabetic dyslipidaemia is characterised by high triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C) and the presence of small, dense low-density lipoprotein (LDL). The UK National Paediatric Diabetes Audit (NPDA) 2013/14 reported that 16.1% of children and young people (CYP) with type 1 diabetes mellitus (T1DM) have a total cholesterol (TC) of ≥ 5 mmol/l. TG, LDL and TC/HDL-C were not reported in the NPDA. The significantly high prevalence of hypercholesterolemia in CYP with T1DM is concerning.
Aim To evaluate the factors associated with dyslipidaemia in CYP with T1DM.
Methods We examined TC, LDL, TG, TC/HDL-C ratio, body mass index (BMI) SDS, mean HbA1c over 12 months, duration of diagnosis, pubertal status and total daily insulin requirement of CYP with T1DM between 2014 and 2015 in 4 paediatric diabetes centres within the Northwest of England.
Results There were 371 patients included (201 males). 250 were on multiple daily insulin regimen, 102 were on continuous subcutaneous insulin infusion (CSII) and 19 were on twice-daily insulin regimen. There were 93 prepubertal, 170 pubertal and 107 post-pubertal CYP. Prevalence of hypercholesterolaemia (TC > 5mmol/L) was higher in our cohort (23.1%) compared to NPDA (16.1%) (Table 1).
There was significant positive correlation between TC and HbA1c (r = 0.3, p = 0.002) (Figure 1).
Demographics
There was significant correlation between TC/HDL-C ratio and HbA1c (p < 0.001). Total daily insulin (p < 0.001) and duration of diagnosis (p = 0.02) were significantly associated with higher TC/HDL-C ratio. Multivariable regression analyses of factors affecting TC, LDL, TG, TC/HDL-C ratio were determined using the following factors: BMI SDS, pubertal status, HbA1c, duration of diagnosis and total daily insulin. HbA1c was an independent factor affecting TC (p < 0.001), TG (p = 0.01), LDL (p = 0.04) and TC/HDL-C ratio (p < 0.001). Total daily insulin was also an independent factor affecting LDL (p = 0.02) and TC/HDL-C ratio (p = 0.005), and BMI SDS was an independent factor affecting TC/HDL-C ratio (p = 0.008).
Conclusion There was a significant relationship between poor glycaemic control and higher TC levels and TC:HDL-C ratio. HbA1c was an independent factor affecting TC, TC:HDL-C, LDL and TG. Poor glycemic control increases the risk of diabetes dyslipidaemia in CYP with T1DM.