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Precision Prediction & Precision Medicine

OPTIMIZING SCREENING OF LIPIDS IN CHILDREN AND ADOLESCENTS WITH T1D

Heyden JCV, Birnie E, Bovenberg SA, Dekker P, Veeze HJ, Mul D, Aanstoot HJ.

Losing Track of Lipids in Children and Adolescents with Type 1 Diabetes: Towards Individualized Patient Care. Exp Clin Endocrinol Diabetes. 2019. [Epub ahead of print]

T1D poses an increased risk of premature cardiovascular disease (CVD) and cardiovascular mortality. On of the risk factors is an abnormal level of low-density cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL cholesterol (non-HDL-C), total cholesterol (TC) and/or triglycerides (TG). LDL-C is considered to be a modifiable risk factor if treatment is initiated early. Thus, screening for lipid abnormalities is important to identify timely. Previous studies have shown that a considerable number of children and adolescents with T1D already show lipid abnormalities, shifting from low-risk to borderline-risk and even high-risk lipid profiles over time, dependent on HbA1c levels, diabetes duration, gender and BMI. A diagnostic algorithm incorporating these factors was used by Schwab et al. to establish reference curves for various lipid parameters for children and adolescents with T1D. In our study we aimed to:

 

  • Establish prevalences of children and adolescents with T1D changing from low-risk lipid levels to borderline-risk levels or from borderline-risk levels to high-risk levels (or ‘losing track of lipids).
  • Assess if the diagnostic algorithm suggested by Schwab et al., with the additional determinants ethnicity and diabetes duration is useable for individual routine patient care.
  • Establish appropriate interval for lipid screening.

 

Key findings:

Most patients started with a low-risk lipid profile.

Quite a few patients changes their lipid profile, of whom 31-43% changed to a worse profile (i.e. lost track of lipids).

The diagnostic algorithm was only moderately able to predict these changes.

The optimal interval to screen for lipid abnormalities was found to range from 13 to 22 months, which is considerably more frequent than the 5-year interval recommended in the international guidelines.

 

The authors conclude that “All these efforts aim to early identify children and adolescents with T1D at high risk for macrovascular complications, so that early intervention, targeted at improving this lifetime perspective of macrovascular complications, can be initiated.

 

Click here for the Pubmed abstract.

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