Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA.
J Pediatr. 2013 Jan;162(1):101-7.e1. doi: 10.1016/j.jpeds.2012.06.006. Epub 2012 Jul 11.
To test the hypothesis that a change in glycated hemoglobin (A1c) over a follow-up interval of approximately 2 years would be associated with concomitant changes in fasting lipids in individuals with type 1 diabetes (T1D).
All subjects with T1D diagnosed in 2002-2005 in the SEARCH for Diabetes in Youth study with at least 2 study visits ∼12 and ∼24 months after an initial visit were included (age at initial visit, 10.6 ± 4.1 years; 48% female; diabetes duration, 10 ± 7 months; 76% non-Hispanic white; A1c = 7.7% ± 1.4%). Longitudinal mixed models were fit to examine the relationship between change in A1c and change in lipid levels (total cholesterol [TC], high-density lipoprotein-cholesterol [HDL-c], low-density lipoprotein-cholesterol [LDL-c], log triglycerides [TG], and non-HDL-c) with adjustment for possible confounders.
Change in A1c over time was significantly associated with changes in TC, HDL-c, LDL-c, TG, and non-HDL-c over the range of A1c values. For example, for a person with an A1c of 10% and then a 2% decrease in A1c 2 years later (to 8%), the model predicted concomitant changes in TC (-0.29 mmol/L, -11.4 mg/dL), HDL-c (0.03 mmol/L, 1.3 mg/dL), LDL-c (-0.23 mmol/L, -9.0 mg/dL), and non-HDL-c (-0.32 mmol/L, -12.4 mg/dL) and an 8.5% decrease in TG (mmol/L).
Improved glucose control over a 2-year follow-up was associated with a more favorable lipid profile but may be insufficient to normalize lipids in dyslipidemic T1D youth needing to decrease lipids to goal.
检验假设，即大约 2 年的随访期间糖化血红蛋白（HbA1c）的变化与 1 型糖尿病（T1D）个体空腹血脂的变化相关。
所有于 2002-2005 年在青少年糖尿病研究（SEARCH for Diabetes in Youth）中确诊为 T1D 的患者，且在初始就诊后约 12 个月和 24 个月时至少有 2 次就诊，均纳入本研究（初始就诊时年龄为 10.6 ± 4.1 岁，48%为女性，糖尿病病程为 10 ± 7 个月，76%为非西班牙裔白人，HbA1c 为 7.7% ± 1.4%）。采用纵向混合模型检验 HbA1c 变化与血脂水平（总胆固醇[TC]、高密度脂蛋白胆固醇[HDL-c]、低密度脂蛋白胆固醇[LDL-c]、对数甘油三酯[TG]和非高密度脂蛋白胆固醇[non-HDL-c]）变化之间的关系，同时对可能的混杂因素进行调整。
HbA1c 随时间的变化与 A1c 值范围内 TC、HDL-c、LDL-c、TG 和 non-HDL-c 的变化显著相关。例如，对于一位 HbA1c 为 10%的患者，2 年后 HbA1c 下降 2%（至 8%），模型预测 TC（-0.29 mmol/L，-11.4 mg/dL）、HDL-c（0.03 mmol/L，1.3 mg/dL）、LDL-c（-0.23 mmol/L，-9.0 mg/dL）和 non-HDL-c（-0.32 mmol/L，-12.4 mg/dL）会相应变化，TG 降低 8.5%（mmol/L）。
随访 2 年期间，血糖控制的改善与更有利的血脂谱相关，但可能不足以使需要降低血脂至目标值的血脂异常 T1D 青少年的血脂正常化。
