Children who experienced partial readmission of new-onset type 1 diabetes had significantly lower total cholesterol levels and LDL cholesterol levels compared with non-remitters four to five years after diagnosis, according to a single-center study published May 16 in PLOS One.
This finding may help physicians identify non-remitters at greater risk for long-term complications and facilitate increased lipid monitoring for children with type 1 diabetes, wrote lead author Benjamin Udoka Nwosu, MD, and colleagues at University of Massachusetts Medical School.
“The early divergence in lipid profile in these children suggests the need to modify the current American Diabetes Association guidelines to allow for the initiation of the assessment of lipid profile at the time of diagnosis to ensure early identification of dyslipidemia in the non-remitters,” the researchers wrote. “These measures will help to reduce the high prevalence of long-term complications in patients with type 1 diabetes.”
Nwosu et al. studied 55 boys and 68 girls an average of 11.9 years old who were completing their checkups four to five years after being diagnosed with type 1 diabetes. Those who met a standard definition for partial clinical remission (PCR) had average LDL-C and total cholesterol levels of 78.8 mg/dL and 151.5 mg/dL, respectively. Non-remitters, on the other hand, had average measures of 91.6 mg/dL for LDL-C and 167.0 mg/dL for total cholesterol.
“An intriguing finding was that when subjects were stratified by BMI (body mass index) status, there was no difference in serum LDL-C concentration between the normal-weight subjects in both groups; however, among the overweight/obese subjects, LDL-C was significantly lower in the remitters compared to non-remitters,” Nwosu and colleagues wrote. “Equally, both LDL-C and TC were similar between prepubertal remitters vs. non-remitters but were significantly lower in remitters in puberty compared to non-remitters in puberty.”
The authors said possible mechanisms for PCR include early normoglycemia and reduced insulin resistance, both of which might protect against elevated cholesterol. But given they didn’t have LDL-C measurements at the onset of diabetes for their study group, they couldn’t rule out that LDL-C was already higher in remitters—or that those individuals had some genetic or other unmeasured risk factors.
“Regardless of the mechanism behind the association, it is our belief that the adoption of a simpler definition of PCR such as TDD (total daily dose of insulin) less than 0.3 units/kg/day would enable an early identification of non-remitters, and in turn, the institution of targeted therapeutic regimens to prevent early dyslipidemia in children and adolescents with type 1 diabetes,” the researchers wrote.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.