Background Early onset of type 1 diabetes (T1DM) has been reported to increase the risk of atherosclerosis. Reports on the prevalence of abnormal lipid profiles in children with T1DM are conflicting.
Objective To assess the prevalence of abnormal lipid profiles in children with T1DM and describe the temporal trends in dyslipidemia. Also to aim to characterize the lipid profiles with regard to ethnicity and to identify the risk factors associated with abnormal lipid profiles in children with T1DM.
Study Design Children with T1DM, followed at the Children's Hospital of Birmingham, Alabama, were included in this retrospective study. Patients were identified using the diagnosis code of 250.1. Only patients with more than one lipid level are included in the study. Children with liver disease, thyroid dysfunction, renal dysfunction, retinopathy, and type 2 diabetes are excluded. The overall lipid analysis including examinations for all children at multiple time points since diagnosis of diabetes is the outcome measure. Lipid profiles are stratified according to the American Heart Association optimal lipid level for children and adolescents.
Results The study included 182 children diagnosed with T1DM from age 1.0 to 16 years with an average of 7.7 ± 2.9 years; 51.3% males and 48.7% females; 76.2% Caucasians and 23.8% African Americans. The mean HbA1c was 10.58 ± 2.2% in African Americans and 8.7 ± 1.6% in Caucasians (p = < .0001). Total cholesterol (TC) was in the high range in 13.23% and LDL cholesterol (LDL-C) was in the high range in only 4.74%. Females had elevated TC, LDL, and non-HDL-C when compared with males. African Americans had elevated TC (p = .0013), TC/HDL-C ratio (p = < .0001) when compared with Caucasians. The longitudinal analysis showed changes in HbA1c over time significantly associated with changes in TC, LDL-C, non-HDL-C, TC/HDL-C, and HDL-C after adjusting for age, sex, and race. African Americans were more affected by the changes in the HbA1c over time with changes in the TC (p = .0079), TC/HDL ratio (p = < .0001), non-HDL-C (p = < .0001), and HDL-C (p = < .0001).
Conclusions Our data clearly indicate that TC, LDL-C, HDL-C, and non-HDL-C are significantly affected by glycemic control over time. The differences in the magnitude of the changes in TC, LDL-C levels to variations in HbA1c in African Americans with T1DM were higher than in whites. We demonstrate that race is a profound risk factor in the relationship between diabetes control and abnormal lipid profile in children with T1DM.