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

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dc.contributor.authorGiuffrida, Fernando de Mello Almada [UNIFESP]
dc.contributor.authorGuedes, Alexis D.
dc.contributor.authorRocco, Eloa Roberta [UNIFESP]
dc.contributor.authorMory, Denise Barreto [UNIFESP]
dc.contributor.authorDualib, Patricia [UNIFESP]
dc.contributor.authorMatos, Odelisa S.
dc.contributor.authorChaves-Fonseca, Reine M.
dc.contributor.authorCobas, Roberta A.
dc.contributor.authorNegrato, Carlos Antonio
dc.contributor.authorGomes, Marilia B.
dc.contributor.authorDib, Sergio Atala [UNIFESP]
dc.contributor.authorBrazilian Type 1 Diabet Study Group
dc.contributor.institutionCEDEBA Ctr Endocrinol Estado Bahia
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionUniversidade do Estado do Rio de Janeiro (UERJ)
dc.contributor.institutionAssoc Diabet Bauru
dc.date.accessioned2016-01-24T14:28:10Z
dc.date.available2016-01-24T14:28:10Z
dc.date.issued2012-12-27
dc.description.abstractBackground: 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.en
dc.description.affiliationCEDEBA Ctr Endocrinol Estado Bahia, Salvador, BA, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Ctr Diabet, São Paulo, Brazil
dc.description.affiliationUniv Estado Rio de Janeiro, Rio de Janeiro, Brazil
dc.description.affiliationAssoc Diabet Bauru, Bauru, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Ctr Diabet, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent8
dc.identifierhttp://dx.doi.org/10.1186/1475-2840-11-156
dc.identifier.citationCardiovascular Diabetology. London: Biomed Central Ltd, v. 11, 8 p., 2012.
dc.identifier.doi10.1186/1475-2840-11-156
dc.identifier.fileWOS000313940900001.pdf
dc.identifier.issn1475-2840
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/35626
dc.identifier.wosWOS:000313940900001
dc.language.isoeng
dc.publisherBiomed Central Ltd
dc.relation.ispartofCardiovascular Diabetology
dc.rightsAcesso aberto
dc.subjectType 1 diabetesen
dc.subjectMetabolic syndromeen
dc.subjectDyslipidemiaen
dc.subjectCardiovascular risk factoren
dc.titleHeterogeneous behavior of lipids according to HbA1(c) levels undermines the plausibility of metabolic syndrome in type 1 diabetes: data from a nationwide multicenter surveyen
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