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

Author:

Loredana Marcovecchio M.1,Neil Dalton R.2,Toby Prevost A.3,Acerini Carlo L.1,Barrett Timothy G.4,Cooper Jason D.5,Edge Julie6,Neil Andrew7,Shield Julian8,Widmer Barry1,Todd John A.5,Dunger David B.1

Affiliation:

1. Department of Paediatrics and the Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge, U.K.;

2. WellChild Laboratory, King's College London, Evelina Children's Hospital, London, U.K.;

3. Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K.;

4. Department of Paediatrics, Birmingham Children's Hospital, Birmingham, U.K.;

5. Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, U.K.;

6. Department of Paediatric Endocrinology and Diabetes, Oxford Children's Hospital, Headington, Oxford, U.K.;

7. Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K.;

8. Institute of Child Life & Health, University of Bristol, Bristol, U.K.

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 < 0.001). A significant proportion of subjects presented sustained lipid abnormalities during follow-up: total cholesterol >5.2 mmol/l (18.6%), non-HDL cholesterol >3.4 mmol/l (25.9%), TG >1.7 mmol/l (20.1%), and LDL cholesterol >3.4 mmol/l (9.6%). Age and duration were significantly related to all lipid parameters (P < 0.001); A1C was independently related to all parameters (P < 0.001) except HDL cholesterol, whereas BMI SD scores were related to all parameters (P < 0.05) except total cholesterol. Total cholesterol and non-HDL cholesterol were independently related to longitudinal changes in ACR (B coefficient ± SE): 0.03 ± 0.01/1 mmol/l, P = 0.009, and 0.32 ± 0.014/1 mmol/l, P = 0.02, respectively. Overall mean total cholesterol and non-HDL cholesterol were higher in microalbuminuria positive (n = 115) than in normoalbuminuric subjects (n = 780): total cholesterol 4.7 ± 1.2 vs. 4.5 ± 0.8 mmol/l (P = 0.04) and non-HDL cholesterol 3.2 ± 1.2 vs. 2.9 ± 0.8 mmol/l (P = 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.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

Reference25 articles.

1. National Institute of Diabetes and Digestive and Kidney Diseases Working Group on Cardiovascular Complications of Type 1 Diabetes Mellitus;Libby;Circulation,2005

2. Diabetic dyslipidaemia;Durrington;Baillieres Best Pract Res Clin Endocrinol Metab,1999

3. Potential influence of lipids in diabetic nephropathy: insights from experimental data and clinical studies;Bonnet;Diabetes Metab,2000

4. Predictors for the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes: inception cohort study;Hovind;BMJ,2004

5. Regression of microalbuminuria in type 1 diabetes;Perkins;N Engl J Med,2003

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