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

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• 作者：David M. Maahs ; MD ; PhD¹ ; ² ; ³ ; ^{David.Maahs@ucdenver.edu} ; Dana Dabelea ; MD ; PhD² ; Ralph B. D'Agostino Jr. ; PhD⁴ ; Jeannette S. Andrews ; MS⁴ ; Amy S. Shah ; MD⁵ ; Nancy Crimmins ; MD⁵ ; Elizabeth J. Mayer-Davis ; PhD⁶ ; Santica Marcovina ; PhD⁷ ; Giuseppina Imperatore ; MD ; PhD⁸ ; R. Paul Wadwa ; MD¹ ; Steven R. Daniels ; MD ; PhD³ ; Kristi Reynolds ; MPH ; PhD⁹ ; Richard F. Hamman ; MD ; DrPH² ; Lawrence M. Dolan ; MD⁵ ; SEARCH for Diabetes in Youth Study &lowast
• 关键词：A1c ; Glycated hemoglobin ; BMI ; Body mass index ; CVD ; Cardiovascular disease ; DCCT ; Diabetes Control and Complications Trial ; HDL-c ; High-density lipoprotein-cholesterol ; LDL-c ; Low-density lipoprotein-cholesterol ; NHW ; Non-Hispanic white ; SEARCH ; SEARCH f
• 刊名：The Journal of Pediatrics
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：162
• 期：1
• 页码：101-107.e1
• 全文大小：456 K

文摘

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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 ¡À 4.1 years; 48 % female; diabetes duration, 10 ¡À 7 months; 76 % non-Hispanic white; A1c = 7.7 % ¡À 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.