Lipid Disorders in Diabetes: Good News, Bad News
KEYSTONE, COLO. — Traditional lipid disorders appear to be less common and better managed today in adults with type 1 diabetes than in matched nondiabetic controls.
That's the good news. The bad news is that overall lipid profiles in children and young adults with type 1 diabetes, both in the United States and Europe, are less favorable than in their older counterparts, Dr. Robert H. Eckel said at a conference on the management of diabetes in youth.
The National Cholesterol Education Program has labeled diabetes a coronary heart disease equivalent, meaning a diabetic individual having no history of coronary heart disease is considered to be at the same risk of a major cardiovascular event as a nondiabetic who has already had an acute MI.
Many physicians caring for diabetic adults appear to have heard this NCEP message loud and clear, as illustrated by baseline data from the Coronary Artery Calcium in Type 1 Diabetes (CACTI) study, said Dr. Eckel, professor of medicine, physiology, and biophysics at the University of Colorado, which together with the Children's Diabetes Foundation, Denver, sponsored the conference.
CACTI showed the prevalence of dyslipidemia was significantly less in 652 type 1 diabetic men and women than in 764 nondiabetic controls, by a margin of 47% versus 58%. Both diabetic men and women had significantly lower mean levels of total cholesterol, LDL cholesterol, and triglycerides as well as significantly higher HDL cholesterol than controls (Diabetes Care 2005;28:1051–6).
Moreover, 52% of diabetic participants with abnormal lipids were aware of that fact, compared with just 34% of controls. And 36% of the type 1 diabetic subjects with dyslipidemia were on medication for it—a rate fourfold greater than in dyslipidemic nondiabetic participants in the Denver-based study, in which Dr. Eckel was a coinvestigator. And control of abnormal lipid levels was achieved in 41% of type 1 diabetic subjects on lipid-modifying therapy, compared with just 15% of treated nondiabetic subjects.
Evidence of heightened physician attention to lipids in adults with type 1 diabetes is encouraging, but the CACTI findings require validation in another study. Besides that, only about half of dyslipidemic type 1 diabetic CACTI participants knew they possessed a major modifiable risk factor for CHD, and undertreatment of this high-risk group was common, noted Dr. Eckel, immediate past president of the American Heart Association.
Turning to lipid trends in younger persons with type 1 diabetes, he noted that colleagues at the University of Colorado found dyslipidemia was more common in 682 children with type 1 diabetes than in historical controls. A total cholesterol level in excess of 200 mg/dL was present in 15.4% of the diabetic youths, compared with 11.2% of controls from the National Health and Nutrition Examination Survey. An elevated total cholesterol and/or HDL cholesterol below 35 mg/dL was found in 18.6% of type 1 diabetic children and 16.3% of controls (J. Pediatr. 2005;147:544–6).
A recent “fairly impressive,” very large German study paints a more unsettling picture, Dr. Eckel continued. The prevalence of dyslipidemia rose significantly with age in the study population.
Only about half of dyslipidemictype 1 diabetic CACTI participants knew they had a major, modifiable risk factor for CHD. DR. ECKEL
