Optimizing screening of lipids in children and adolescents with type 1 diabetes
Heyden JCV, Birnie E, Bovenberg SA, Dekker P, Veeze HJ, Mul D, Aanstoot HJ.
Losing Track of Lipids in Children and Adolescents with Type 1 Diabetes: Towards Individualized Patient Care. Exp Clin Endocrinol Diabetes. 2021 Jul;129(7):510-518.
Type 1 diabetes poses an increased risk of premature cardiovascular disease (CVD) and cardiovascular mortality. On of the risk factors is an abnormal level of low-density cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL cholesterol (non-HDL-C), total cholesterol (TC) and/or triglycerides (TG). LDL-C is considered to be a modifiable risk factor if treatment is initiated early. Thus, screening for lipid abnormalities is important to identify timely. Previous studies have shown that a considerable number of children and adolescents with type 1 diabetes already show lipid abnormalities, shifting from low-risk to borderline-risk and even high-risk lipid profiles over time, dependent on HbA1c levels, diabetes duration, gender and BMI. A diagnostic algorithm incorporating these factors was used by Schwab et al. to establish reference curves for various lipid parameters for children and adolescents with type 1 diabetes. In our study we aimed to:
- Establish prevalences of children and adolescents with type 1 diabetes changing from low-risk lipid levels to borderline-risk levels or from borderline-risk levels to high-risk levels (or ‘losing track of lipids).
- Assess if the diagnostic algorithm suggested by Schwab et al., with the additional determinants ethnicity and diabetes duration is useable for individual routine care.
- Establish appropriate interval for lipid screening.
Key findings:
- Most people with type 1 diabetes started with a low-risk lipid profile.
- Quite a few people changes their lipid profile, of whom 31-43% changed to a worse profile (i.e. lost track of lipids).
- The diagnostic algorithm was only moderately able to predict these changes.
- The optimal interval to screen for lipid abnormalities was found to range from 13 to 22 months, which is considerably more frequent than the 5-year interval recommended in the international guidelines.
Concluding, the authors state
"All these efforts aim to early identify children and adolescents with type 1 diabetes at high risk for macrovascular complications, so that early intervention, targeted at improving this lifetime perspective of macrovascular complications, can be initiated." -
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