Clinical remission in newly diagnosed type 1 diabetes mellitus and HDL function on cholesterol efflux capacity: prospective InLipoDiab1 study.

SUMMARY

Type 1 diabetes mellitus (DM1) is characterized by high serum HDL, which does not translate into a better prognosis. It is probably related to the impaired function of HDL particles. One of the functions of HDL is reverse cholesterol transport (cholesterol efflux capacity, CEC). Beneficial for management and prognosis in DM1 is the occurrence of partial clinical remission (pCR). It is not known whether the changes in CEC are related to the presence of pCR. The aim was to evaluate the relationship between CEC and pCR in newly diagnosed DM1 during 12 months. The analysis comprised 127 adults (68% men) with newly diagnosed DM1. CEC was assessed in UT Southwestern Medical Center by measuring the efflux of radiolabeled cholesterol from murine J774 macrophages to apolipoprotein B-depleted serum. The study was performed at two points: at disease onset and after 1 year. pCR was defined as insulin dose-adjusted A1C as A1C (percent) + (4 × insulin dose) ≤9. After 1 year of observation, a significant increase in serum HDL concentration and no change in CEC were demonstrated in the whole group (1.28 (1.11-1.41) vs 1.23 (1.14-1.42), P = 0.6). There was a CEC improvement in women with pCR after 1 year 1.28 (1.04-1.38) vs 1.31 (1.08-1.42), P = 0.05. No relationship was revealed between pCR and CEC (OR 1.8 (CI 95% 0.12-26.8), P = 0.7). In DM1, during the first year of the disease, there was no improvement in CEC despite a significant increase in serum HDL cholesterol concentration. There was no relationship between CEC and pCR. Good metabolic control in pCR has a beneficial impact on CEC.

ARTICLE HIGHLIGHTS

Increased HDL serum cholesterol concentration is not associated with improved HDL function. HDL particles are functionally impaired from the onset of type 1 diabetes. There is no relationship between cholesterol efflux capacity and clinical remission of type 1 diabetes. A change in viewpoint on high HDL cholesterol levels in people with type 1 diabetes as a protective factor for the development of diabetes complications and the awareness that HDL cholesterol levels alone are insufficient to assess the cardiovascular risk in this group of patients.

CLINICALTRIALS NUMBER

NCT02306005.