The online version of this article (doi:10.1186/1475-2840-11-156) contains supplementary material, which is available to authorized users.
All authors declare that they have no competing interests.
FMAG conceived the study, performed the statistical analyses and drafted the manuscript; ADG, PD, OSM, RMCF, RC, CAN, and MBG collected data on individuals with type 1 diabetes and provided critical appraisal during the drafting of the manuscript; ERR and DBM collected data on non-diabetic individuals and provided critical appraisal during the drafting of the manuscript; SAD conceived the study, drafted the manuscript, collected data on individuals with type 1 diabetes, supervised the project, and is the guarantor of this study. All authors read and approved the final manuscript.
Cardiovascular risk factors (CVRF) may cluster in type 1 diabetes, analogously to the metabolic syndrome described in type 2 diabetes. The threshold of HbA1c above which lipid variables start changing behavior is unclear. This study aims to 1) assess the behavior of dyslipidemia according to HbA1c values; 2) detect a threshold of HbA1c beyond which lipids start to change and 3) compare the clustering of lipids and other non-lipid CVRF among strata of HbA1c individuals with type 1 diabetes.
Effects of HbA1c quintiles (1st: ≤7.4%; 2nd: 7.5-8.5%; 3rd: 8.6-9.6%; 4th: 9.7-11.3%; and 5th: >11.5%) and covariates (gender, BMI, blood pressure, insulin daily dose, lipids, statin use, diabetes duration) on dyslipidemia were studied in 1275 individuals from the Brazilian multi-centre type 1 diabetes study and 171 normal controls.
Body size and blood pressure were not correlated to lipids and glycemic control. OR (99% CI) for high-LDL were 2.07 (1.21-3.54) and 2.51 (1.46-4.31), in the 4th and 5th HbA1c quintiles, respectively. Hypertriglyceridemia increased in the 5th quintile of HbA1c, OR 2.76 (1.20-6.37). OR of low-HDL-cholesterol were 0.48 (0.24-0.98) and 0.41 (0.19-0.85) in the 3rd and 4th HbA1c quintiles, respectively. HDL-cholesterol correlated positively (0.437) with HbA1c in the 3rd quintile. HDL-cholesterol and insulin dose correlated inversely in all levels of glycemic control.
Correlation of serum lipids with HbA1c is heterogeneous across the spectrum of glycemic control in type 1 diabetes individuals. LDL-cholesterol and triglycerides worsened alongside HbA1c with distinct thresholds. Association of lower HDL-cholesterol with higher daily insulin dose is consistent and it points out to a role of exogenous hyperinsulinemia in the pathophysiology of the CVRF clustering. These data suggest diverse pathophysiological processes depending on HbA1c, refuting a unified explanation for cardiovascular risk in type 1 diabetes.
Margeirsdottir HD, Larsen JR, Brunborg C, Øverby NC, Dahl-Jørgensen K, Norwegian Study Group for Childhood Diabetes: High prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes: a population-based study. Diabetologia. 2008, 51: 554-561. 10.1007/s00125-007-0921-8. CrossRefPubMed
American Diabetes Association: Executive summary: Standards of medical care in diabetes--2012. Diabetes Care. 2012, 35 (1): S4-S10. CrossRef
Leosdottir M, Willenheimer R, Persson M, Nilsson PM: The association between glucometabolic disturbances, traditional cardiovascular risk factors and self-rated health by age and gender: a cross-sectional analysis within the Malmö Preventive Project. Cardiovasc Diabetol. 2011, 10: 118-10.1186/1475-2840-10-118. PubMedCentralCrossRefPubMed
Schwab KO, Doerfer J, Naeke A, Rohrer T, Wiemann D, Marg W, Hofer SE, Holl RW: German/Austrian Pediatric DPV Initiative: Influence of food intake, age, gender, HbA1c, and BMI levels on plasma cholesterol in 29,979 children and adolescents with type 1 diabetes–reference data from the German diabetes documentation and quality management system (DPV). Pediatr Diabetes. 2009, 10: 184-192. 10.1111/j.1399-5448.2008.00469.x. CrossRefPubMed
Dabelea D, Kinney G, Snell-Bergeon JK, Hokanson JE, Eckel RH, Ehrlich J, Garg S, Hamman RF, Rewers M: Coronary Artery Calcification in Type 1 Diabetes Study: Effect of type 1 diabetes on the gender difference in coronary artery calcification: a role for insulin resistance? The Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study. Diabetes. 2003, 52: 2833-2839. 10.2337/diabetes.52.11.2833. CrossRefPubMed
Dalla Pozza R, Beyerlein A, Thilmany C, Weissenbacher C, Netz H, Schmidt H, Bechtold S: The effect of cardiovascular risk factors on the longitudinal evolution of the carotid intima medial thickness in children with type 1 diabetes mellitus. Cardiovasc Diabetol. 2011, 10: 53-10.1186/1475-2840-10-53. PubMedCentralCrossRefPubMed
van Vliet M, Van der Heyden JC, Diamant M, Rosenstiel Von IA, Schindhelm RK, Heymans MW, Brandjes DPM, Beijnen JH, Aanstoot HJ, Veeze HJ: Overweight children with type 1 diabetes have a more favourable lipid profile than overweight non-diabetic children. Eur J Pediatr. 2011, 171: 493-498. PubMedCentralCrossRefPubMed
Guy J, Ogden L, Wadwa RP, Hamman RF, Mayer-Davis EJ, Liese AD, D'Agostino RB, Marcovina S, Dabelea D: Lipid and lipoprotein profiles in youth with and without type 1 diabetes: the SEARCH for Diabetes in Youth case–control study. Diabetes Care. 2009, 32: 416-420. 10.2337/dc08-1775. PubMedCentralCrossRefPubMed
Valerio G, Iafusco D, Zucchini S, Maffeis C: Study-Group on Diabetes of Italian Society of Pediatric Endocrinology and Diabetology (ISPED): Abdominal adiposity and cardiovascular risk factors in adolescents with type 1 diabetes. Diabetes Res Clin Pract. 2012, 97: 99-104. 10.1016/j.diabres.2012.01.022. CrossRefPubMed
Pladevall M, Singal B, Williams LK, Brotons C, Guyer H, Sadurni J, Falces C, Serrano-Rios M, Gabriel R, Shaw JE, Zimmet PZ, Haffner S: A single factor underlies the metabolic syndrome: a confirmatory factor analysis. Diabetes Care. 2006, 29: 113-122. 10.2337/diacare.29.01.06.dc05-0862. CrossRefPubMed
Mayer-Davis EJ, Ma B, Lawson A, D'Agostino RB, Liese AD, Bell RA, Dabelea D, Dolan L, Pettitt DJ, Rodriguez BL, Williams D, SEARCH for Diabetes in Youth Study Group: Cardiovascular disease risk factors in youth with type 1 and type 2 diabetes: implications of a factor analysis of clustering. Metab Syndr Relat Disord. 2008, 7: 89-95. CrossRef
Gomes MB, Coral M, Cobas RA, Dib SA, Canani LH, Nery M, de Freitas MCF, Faria M, Felício JS, da Silva SC, Pedrosa H, Costa E, Forti A, Rea RR, Pires AC, Montenegro Junior R, Oliveira JE, Rassi N, Negrato CA: Prevalence of adults with type 1 diabetes who meet the goals of care in daily clinical practice: a nationwide multicenter study in Brazil. Diabetes Res Clin Pract. 2012, 97: 63-70. 10.1016/j.diabres.2012.02.008. CrossRefPubMed
National Cholesterol Education Program (NCEP) Expert Panel on Detection: Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002, 106: 3143-3421.
Rocco ER, Mory DB, Bergamin CS, Valente F, Miranda VL, Calegare BFA, Silva RQ, Dib SA: Optimal cutoff points for body mass index, waist circumference and HOMA-IR to identify a cluster of cardiometabolic abnormalities in normal glucose-tolerant Brazilian children and adolescents. Arq Bras Endocrinol Metabol. 2011, 55: 638-645. 10.1590/S0004-27302011000800020. CrossRefPubMed
Idzior-Walus B, Mattock MB, Solnica B, Stevens L, Fuller JH: EURODIAB IDDM Complications Study Group: Factors associated with plasma lipids and lipoproteins in type 1 diabetes mellitus: the EURODIAB IDDM Complications Study. Diabet Med. 2001, 18: 786-796. 10.1046/j.0742-3071.2001.00571.x. CrossRefPubMed
Maahs DM, Hokanson JE, Wang H, Kinney GL, Snell-Bergeon JK, East A, Bergman BC, Schauer IE, Rewers M, Eckel RH: Lipoprotein subfraction cholesterol distribution is proatherogenic in women with type 1 diabetes and insulin resistance. Diabetes. 2010, 59: 1771-1779. 10.2337/db09-1626. PubMedCentralCrossRefPubMed
Thorn LM, Forsblom C, Fagerudd J, Thomas MC, Pettersson-Fernholm K, Saraheimo M, Wadén J, Rönnback M, Rosengård-Bärlund M, Björkesten C-GA, Taskinen M-R, Groop P-H, FinnDiane Study Group: Metabolic syndrome in type 1 diabetes: association with diabetic nephropathy and glycemic control (the FinnDiane study). Diabetes Care. 2005, 28: 2019-2024. 10.2337/diacare.28.8.2019. CrossRefPubMed
Cleland SJ: Cardiovascular risk in double diabetes mellitus–when two worlds collide. Nat Publ Group. 2012, 8: 476-485.
Kline P: An Easy Guide to Factor Analysis. 1993, East Sussex: Routledge, 1st
- Heterogeneous behavior of lipids according to HbA1c levels undermines the plausibility of metabolic syndrome in type 1 diabetes: data from a nationwide multicenter survey
Fernando MA Giuffrida
Alexis D Guedes
Eloa R Rocco
Denise B Mory
Odelisa S Matos
Reine M Chaves-Fonseca
Roberta A Cobas
Carlos Antonio Negrato
Marilia B Gomes
Sergio A Dib
Brazilian Type 1 Diabetes Study Group (BrazDiab1SG)
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