Article

Diabetologia

, Volume 53, Issue 12, pp 2518-2525

First online:

Association of glycaemia with lipids in adults with type 1 diabetes: modification by dyslipidaemia medication

  • D. M. MaahsAffiliated withBarbara Davis Center for Childhood Diabetes, University of Colorado DenverDepartment of Epidemiology, Colorado School of Public Health, University of Colorado DenverThe Children’s Hospital Denver Email author 
  • , L. G. OgdenAffiliated withColorado School of Public Health, Department of Biostatistics and Informatics, University of Colorado Denver
  • , D. DabeleaAffiliated withDepartment of Epidemiology, Colorado School of Public Health, University of Colorado Denver
  • , J. K. Snell-BergeonAffiliated withBarbara Davis Center for Childhood Diabetes, University of Colorado Denver
  • , S. R. DanielsAffiliated withDepartment of Epidemiology, Colorado School of Public Health, University of Colorado DenverThe Children’s Hospital Denver
  • , R. F. HammanAffiliated withDepartment of Epidemiology, Colorado School of Public Health, University of Colorado Denver
  • , M. RewersAffiliated withBarbara Davis Center for Childhood Diabetes, University of Colorado DenverDepartment of Epidemiology, Colorado School of Public Health, University of Colorado Denver

Abstract

Aims/hypothesis

Hyperglycaemia and dyslipidaemia are common metabolic abnormalities in adults with type 1 diabetes and both increase cardiovascular disease (CVD) risk. The hypothesis of this study was that change in HbA1c over 6 years would be associated with change in fasting lipids in adults with type 1 diabetes.

Methods

The Coronary Artery Calcification in Type 1 Diabetes (CACTI) study examined 652 patients with type 1 diabetes (54% female); 559 and 543 had follow-up visits at 3 and 6 years. Baseline age (mean ± SD) was 37 ± 9 years, diabetes duration 23 ± 9 years, and HbA1c 8.0 ± 1.3%. Use of dyslipidaemia medication was 17%, 32%, and 46% at the three visits. Separate longitudinal mixed models were fitted to examine the relationship between change in HbA1c and change in fasting total cholesterol (TC), HDL-cholesterol (HDL-c), LDL-cholesterol (LDL-c), log triacylglycerols (TG), and non-HDL-cholesterol (non-HDL-c). Because of an interaction between dyslipidaemia medication use and association of HbA1c with lipids, results were stratified by dyslipidaemia medication use.

Results

Among patients not using dyslipidaemia medication, a higher HbA1c was associated with significantly worse levels of the lipids TC, LDL-c, TG and non-HDL-c (per 1% change in HbA1c, TC 0.101 mmol/l, 95% CI 0.050, 0.152; LDL-c 0.103 mmol/l, 95% CI 0.058, 0.148; TG 0.052 mmol/l, 95% CI 0.024, 0.081; and non-HDL-c 0.129 mmol/l, 95% CI 0.078, 0.180) but not HDL-c (−0.20 mmol/l, 95% CI −0.047, 0.007). The associations between HbA1c and any lipid outcome among those on dyslipidaemia medication were in the same direction, but attenuated compared with persons not on medication.

Conclusions/interpretation

Change in HbA1c is significantly associated with change in fasting lipids, but dyslipidaemia medications may be required to optimise lipid and cardiovascular health.

Keywords

CVD risk Dyslipidaemia medications Glycaemia Lipids Type 1 diabetes