Shah Amy S, Maahs David M, Stafford Jeanette M, Dolan Lawrence M, Lang Wei, Imperatore Giuseppina, Bell Ronny A, Liese Angela D, Reynolds Kristi, Pihoker Catherine, Marcovina Santica, D'Agostino Ralph B, Dabelea Dana
Department of Pediatrics, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, OH
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
Diabetes Care. 2017 Apr;40(4):607-613. doi: 10.2337/dc16-2193. Epub 2017 Jan 26.
Understanding the risk factors associated with progression and regression of dyslipidemia in youth with type 1 diabetes may guide treatments.
We studied 1,478 youth with type 1 diabetes (age 10.8 ± 3.9 years, 50% male, 77% non-Hispanic white, not on lipid-lowering medications) at baseline and at a mean follow-up of 7.1 ± 1.9 years in the SEARCH for Diabetes in Youth (SEARCH) study. Progression to dyslipidemia was defined as normal lipid concentrations at baseline and abnormal at follow-up (non-HDL-cholesterol [C] >130 mg/dL or HDL-C <35 mg/dL). Regression was defined as abnormal lipids at baseline and normal at follow-up. Multivariable logistic regression was used to evaluate factors associated with progression and regression compared with stable normal and stable abnormal, respectively. An area under the curve (AUC) variable was used for the time-varying covariates A1C and waist-to-height ratio (WHtR).
Non-HDL-C progressed, regressed, was stable normal, and stable abnormal in 19%, 5%, 69%, and 7% of youth with type 1 diabetes, respectively. Corresponding percentages for HDL-C were 3%, 3%, 94%, and 1%, respectively. Factors associated with non-HDL-C progression were higher A1C AUC and higher WHtR AUC in males. Non-HDL-C regression was associated with lower WHtR AUC, and HDL-C progression was associated with male sex and higher WHtR AUC. HDL-C regression was not modeled due to small numbers.
A1C and WHtR are modifiable risk factors associated with change in dyslipidemia over time in youth with type 1 diabetes.
了解1型糖尿病青年血脂异常进展和逆转的相关危险因素可能有助于指导治疗。
我们在青少年糖尿病研究（SEARCH）中，对1478例1型糖尿病青年（年龄10.8±3.9岁，50%为男性，77%为非西班牙裔白人，未服用降脂药物）进行了基线研究，并在平均7.1±1.9年的随访中进行了观察。血脂异常进展定义为基线时血脂浓度正常而随访时异常（非高密度脂蛋白胆固醇[C]>130mg/dL或高密度脂蛋白胆固醇<35mg/dL）。逆转定义为基线时血脂异常而随访时正常。多变量逻辑回归分别用于评估与进展和逆转相关的因素，并与稳定正常和稳定异常情况进行比较。曲线下面积（AUC）变量用于时变协变量糖化血红蛋白（A1C）和腰高比（WHtR）。
在1型糖尿病青年中，非高密度脂蛋白胆固醇进展、逆转、稳定正常和稳定异常的比例分别为19%、5%、69%和7%。高密度脂蛋白胆固醇的相应比例分别为3%、3%、94%和1%。与非高密度脂蛋白胆固醇进展相关的因素包括男性中较高的A1C AUC和较高的WHtR AUC。非高密度脂蛋白胆固醇逆转与较低的WHtR AUC相关，而高密度脂蛋白胆固醇进展与男性性别和较高的WHtR AUC相关。由于例数较少，未对高密度脂蛋白胆固醇逆转进行建模。
A1C和WHtR是与1型糖尿病青年血脂异常随时间变化相关的可改变危险因素。
