Higher hemoglobin A1C and atherogenic lipoprotein profiles in children and adolescents with type 2 diabetes mellitus.

AIM: Significant knowledge gaps exist regarding lipoprotein profiles in children with type 2 diabetes mellitus (T2DM). The primary objective was to analyze the type and nature of lipoprotein abnormalities present in children with T2DM and to identify determinants of adverse lipoprotein profiles. The secondary objective was to assess associations with elevated glycated hemoglobin (HbA1C), i.e., <8% vs. ≥8.0% and pediatric dyslipidemias in the setting of T2DM. METHODS: This retrospective chart review included children with T2DM who had undergone lipoprotein analysis and were not on lipid lowering medications (n = 93). RESULTS: The participants (mean age 15.2 ±â€¯2.7y) were 71% female and 78% African American (AA). Adjusted for age, sex, and race, BMI z-score was positively associated with LDL-pattern B (pro-atherogenic profile with small dense LDL particles) (P = 0.01), and negatively associated with total HDL-C (P = 0.0003). HbA1C was robustly positively associated with the LDL-C, apoB and LDL pattern B (all P < 0.001). Patients with an HbA1C >8% had significantly higher total cholesterol (191.4 vs. 158.1 mg/dL, P = 0.0004), LDL-C (117.77 vs. 92.3 mg/dL, P = 0.002), apoB (99.5 vs. 80.9 mg/dL, P = 0.002), non-HDL-C (141.5 vs. 112.5, P = 0.002), and frequency of LDL pattern B (57% vs. 20%, P = 0.0008). CONCLUSION: HbA1C and BMI were associated with adverse lipoprotein profiles, and may represent two major modifiable cardiovascular risk factors in the pediatric T2DM population. Patients with an HbA1C higher than 8.0% had significantly worse atherogenic lipid profile, i.e., higher LDL-C, non-HDL-C, apoB and LDL pattern B, suggesting adequate glycemia may improve adverse lipoprotein profiles.

Overweight adolescents with type 2 diabetes have significantly higher lipoprotein abnormalities than those with type 1 diabetes.

AIM: Diabetes-associated glucoregulatory derangements may precipitate atherogenesis in childhood and CVD risk, particularly with obesity. We aimed to delineate lipoprotein profile differences between children with type 1 and 2 diabetes who are overweight/obese. METHODS: Data were obtained from electronic medical records of patients ≥85th BMI percentile with type 1 (n=159) and type 2 (n=77) diabetes, ages 12-19y. Group differences were evaluated by correlations and general linear modeling analysis, adjusting for BMI, HbA1c, and diabetes duration. RESULTS: There were no group differences in TC, LDL, or non-HDL. Fewer subjects with type 1 diabetes had low HDL (17 vs. 30%; P<0.05). While no difference in HbA1c level was observed between groups, HbA1c was positively correlated with TC (P≤0.0001), LDL (P≤0.0001), non-HDL (P≤0.0001), ApoB100 (P≤0.0001), and LDL pattern B (P≤0.0001). In adjusted models, apoB100 (85.4 vs. 91.3mg/dl; P<0.05) and incidence of LDL pattern B (21 vs. 42%; P<0.01) were lower in subjects with type 1 diabetes. BMI was inversely correlated with HDL, HDL-2 and HDL-3 (all P≤0.0001). The correlation of BMI with HDL-2 and HDL-3 were attenuated when evaluating subjects by diabetes type. CONCLUSIONS: Despite having no difference in absolute LDL levels, children with type 2 diabetes were more likely to have small, dense LDL particle pattern, higher apo B100 and lower total HDL, HDL-2, and HDL-3 fractions. Furthermore, poor glycemic control was associated with abnormal lipoprotein profiles in patients with both type 1 and 2 diabetes.