Prevalence of Abnormal Lipid Profiles and the Relationship With the Development of Microalbuminuria in Adolescents With Type 1 Diabetes
- M. Loredana Marcovecchio, MD1,
- R. Neil Dalton, PHD2,
- A. Toby Prevost, PHD3,
- Carlo L. Acerini, MD1,
- Timothy G. Barrett, PHD4,
- Jason D. Cooper, PHD5,
- Julie Edge, MD6,
- Andrew Neil, FRCP7,
- Julian Shield, MD8,
- Barry Widmer1,
- John A. Todd, PHD5 and
- David B. Dunger, MD1
- 1Department of Paediatrics and the Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge, U.K.;
- 2WellChild Laboratory, King's College London, Evelina Children's Hospital, London, U.K.;
- 3Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K.;
- 4Department of Paediatrics, Birmingham Children's Hospital, Birmingham, U.K.;
- 5Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, U.K.;
- 6Department of Paediatric Endocrinology and Diabetes, Oxford Children's Hospital, Headington, Oxford, U.K.;
- 7Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K.;
- 8Institute of Child Life & Health, University of Bristol, Bristol, U.K.
- Corresponding author: David B. Dunger, dbd25{at}cam.ac.uk.
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.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received September 5, 2008.
- Accepted January 13, 2009.
- © 2009 by the American Diabetes Association.
