Heterogeneous behavior of lipids according to HbA1(c) levels undermines the plausibility of metabolic syndrome in type 1 diabetes: data from a nationwide multicenter survey

Heterogeneous behavior of lipids according to HbA1(c) levels undermines the plausibility of metabolic syndrome in type 1 diabetes: data from a nationwide multicenter survey

Author Giuffrida, Fernando de Mello Almada Autor UNIFESP Google Scholar
Guedes, Alexis D. Google Scholar
Rocco, Eloa Roberta Autor UNIFESP Google Scholar
Mory, Denise Barreto Autor UNIFESP Google Scholar
Dualib, Patricia Autor UNIFESP Google Scholar
Matos, Odelisa S. Google Scholar
Chaves-Fonseca, Reine M. Google Scholar
Cobas, Roberta A. Google Scholar
Negrato, Carlos Antonio Google Scholar
Gomes, Marilia B. Google Scholar
Dib, Sergio Atala Autor UNIFESP Google Scholar
Brazilian Type 1 Diabet Study Group Google Scholar
Institution CEDEBA Ctr Endocrinol Estado Bahia
Universidade Federal de São Paulo (UNIFESP)
Universidade do Estado do Rio de Janeiro (UERJ)
Assoc Diabet Bauru
Abstract Background: Cardiovascular risk factors (CVRF) may cluster in type 1 diabetes, analogously to the metabolic syndrome described in type 2 diabetes. the threshold of HbA1(c) above which lipid variables start changing behavior is unclear. This study aims to 1) assess the behavior of dyslipidemia according to HbA1(c) values; 2) detect a threshold of HbA1(c) beyond which lipids start to change and 3) compare the clustering of lipids and other non-lipid CVRF among strata of HbA1(c) individuals with type 1 diabetes.Methods: Effects of HbA1(c) quintiles (1st: <= 7.4%; 2nd: 7.5-8.5%; 3rd: 8.6-9.6%; 4th: 9.7-11.3%; and 5th: > 11.5%) and covariates (gender, BMI, blood pressure, insulin daily dose, lipids, statin use, diabetes duration) on dyslipidemia were studied in 1275 individuals from the Brazilian multi-centre type 1 diabetes study and 171 normal controls.Results: Body size and blood pressure were not correlated to lipids and glycemic control. OR (99% CI) for high-LDL were 2.07 (1.21-3.54) and 2.51 (1.46-4.31), in the 4th and 5th HbA1(c) quintiles, respectively. Hypertriglyceridemia increased in the 5th quintile of HbA1(c), OR 2.76 (1.20-6.37). OR of low-HDL-cholesterol were 0.48 (0.24-0.98) and 0.41 (0.19-0.85) in the 3rd and 4th HbA1(c) quintiles, respectively. HDL-cholesterol correlated positively (0.437) with HbA1(c) in the 3rd quintile. HDL-cholesterol and insulin dose correlated inversely in all levels of glycemic control.Conclusions: Correlation of serum lipids with HbA1(c) is heterogeneous across the spectrum of glycemic control in type 1 diabetes individuals. LDL-cholesterol and triglycerides worsened alongside HbA1(c) with distinct thresholds. Association of lower HDL-cholesterol with higher daily insulin dose is consistent and it points out to a role of exogenous hyperinsulinemia in the pathophysiology of the CVRF clustering. These data suggest diverse pathophysiological processes depending on HbA1(c), refuting a unified explanation for cardiovascular risk in type 1 diabetes.
Keywords Type 1 diabetes
Metabolic syndrome
Cardiovascular risk factor
Language English
Date 2012-12-27
Published in Cardiovascular Diabetology. London: Biomed Central Ltd, v. 11, 8 p., 2012.
ISSN 1475-2840 (Sherpa/Romeo, impact factor)
Publisher Biomed Central Ltd
Extent 8
Origin http://dx.doi.org/10.1186/1475-2840-11-156
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000313940900001
URI http://repositorio.unifesp.br/handle/11600/35626

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