DYSLIPIDAEMIA IN CHILDREN WITH TYPE 1 DIABETES MELLITUS (T1DM)

Abstract

INTRODUCTION
Children with T1DM are at risk of early microvascular and macrovascular complications. Poor glycaemic control and insulin resistance status in adolescents are known risk factors. This audit studies the prevalence of dyslipidemia in children with T1DM seen in UMMC.

METHODOLOGY
This is a retrospective data collection involving all children with T1DM under UMMC follow-up between 2016- 2018. Children between 11-18 years old were included. Demographics on onset of diabetes, diabetes control and lipid profiles were analysed. Optimal HbA1c is <7.5% and dyslipidemia are defined if total cholesterol (TC)>5.2 mmol/L, triglycerides (TG)>1.7 mmol/L and high LDL level is >2.6 mmol/L which requires interventions on metabolic control and lifestyle. Statin should be commenced in children aged≥11 years if LDL is >3.4 mmol/L [ISPAD].

RESULTS
65 (33%male) children were eligible for the audit. Only 56 (86%) children had dyslipidemia screening. There were 28% Malay, 17% Chinese and 17% Indian children. The current mean age was 14.3±1.9 years old. 7.7% were underweight and 26.1% were overweight/obese. Mean age at diagnosis was 8.7±3.0 years old. Mean diabetes duration was 5.7±3.2 years. Mean HbA1c was 9.9±2.4% with 89% of them having sub-optimal control. Thirty-eight (68%) had dyslipidemia; 38% had abnormal TC levels, 23% had abnormal TG levels and 57% had abnormal LDL levels. 39% of children had LDL between 2.6-3.4 mmol/L and 18% had LDL>3.4 mmol/L. Only 2 were treated with statins. The odds of having dyslipidemia is highest in most poorly controlled T1DM (OR8.6 in HbA1c>11.1%, OR3.7 in 9-11%, OR1.5 if HbA1c 7.5-9%) and 2.31 in those who are overweight/obese. However, despite having good control (HbA1c<7.5%), 5.5% of T1DM children have dyslipidemia.

CONCLUSION
Children with T1DM are at risk of early onset dyslipidemia. Poor diabetes control and obesity are contributing factors. Current practice is to optimise diabetic control instead of using statins as initial treatment. Long term outcome on early statin use may influence the current practice.