title: Prevalence and phenotypic distribution of dyslipidemia in type 1 diabetes mellitus: effect of glycemic control.
abstract: BACKGROUND
  Data on the prevalence of dyslipidemia in type 1 diabetes mellitus are scarce and are based on total triglyceride and total cholesterol concentrations alone.
  
  
  OBJECTIVE
  To assess the effect of glycemic optimization on the prevalence of dyslipidemia and low-density lipoprotein cholesterol (LDL-C) concentrations requiring intervention in patients with type 1 diabetes.
  
  
  METHODS
  A total of 334 adults with type 1 diabetes and 803 nondiabetic control subjects.
  
  
  METHODS
  Levels of glycosylated hemoglobin, total cholesterol, total triglyceride, high-density lipoprotein cholesterol (HDL-C), and LDL-C were assessed at baseline and after 3 to 6 months of intensive therapy with multiple insulin doses.
  
  
  RESULTS
  Levels of LDL-C greater than 4.13 mmol/L (>160 mg/dL) and total triglyceride greater than 2.25 mmol/L (>200 mg/dL) and low HDL-C levels (<0.9 mmol/L [<35 mg/dL] in men or <1.1 mmol/L [<45 mg/dL] in women) were found in 16%, 5%, and 20% of patients and 13%, 6%, and 9% of controls, respectively (P<.001 for HDL-C). Diabetic women showed more hypercholesterolemia than nondiabetic women (15.6% vs 8.5%; P =.04). After glycemic optimization (mean +/- SD glycosylated hemoglobin decrease, 2.2 +/- 1.96 percentage points), the prevalence of LDL-C levels greater than 4.13 mmol/L (>160 mg/dL) became lower in diabetic men than in nondiabetic men (9.7% vs 17.5%; P =.04), but women showed frequencies of dyslipidemia similar to their nondiabetic counterparts. The proportion of patients with LDL-C concentrations requiring lifestyle (>2.6 mmol/L [>100 mg/dL]) or drug (>3.4 mmol/L [>130 mg/dL]) intervention decreased from 78% and 42% to 66% and 26%, respectively.
  
  
  CONCLUSIONS
  Low HDL-C is the most frequent dyslipidemic disorder in patients with poorly controlled insulin-treated type 1 diabetes, and a high proportion show LDL-C levels requiring intervention. Less favorable lipid profiles could explain the absence of sex protection in diabetic women. The improvement caused by glycemic optimization puts forward intensive therapy as the initial treatment of choice for dyslipidemia in poorly controlled type 1 diabetes.
authors.affiliation: Department of Endocrinology and Nutrition, Hospital de Sant Pau, S Antonio M Claret 167, 08025 Barcelona, Spain. aperez@santpau.es
authors.forename: A
authors.initials: A
authors.lastname: Pérez
authors.forename: A M
authors.initials: AM
authors.lastname: Wägner
authors.forename: G
authors.initials: G
authors.lastname: Carreras
authors.forename: G
authors.initials: G
authors.lastname: Giménez
authors.forename: J L
authors.initials: JL
authors.lastname: Sánchez-Quesada
authors.forename: M
authors.initials: M
authors.lastname: Rigla
authors.forename: J A
authors.initials: JA
authors.lastname: Gómez-Gerique
authors.forename: J M
authors.initials: JM
authors.lastname: Pou
authors.forename: A
authors.initials: A
authors.lastname: de Leiva
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000097:blood / Q000175:diagnosis / Q000235:genetics; D001786:Blood Glucose / Q000378:metabolism*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000235:genetics*; D004334:Drug Administration Schedule; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008072:Hyperlipoproteinemia Type I / Q000097:blood / Q000175:diagnosis / Q000235:genetics*; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007328:Insulin; D014280:Triglycerides