Glycaemic control and familial factors determine hyperlipidaemia in early childhood diabetes

Aims To determine whether abnormal lipid levels in children with Type 1 dia betes mellitus are the result of poor metabolic control or may in part be d etermined by genetic factors. Methods Non-fasting lipid levels were measured in 141 children with Type 1 diabetes (age range 7.7-19 years) 3 years after diagnosis, and in 192 of th eir parents. Glycosylated haemoglobin and the urinary albumin-creatinine ra tio (three urine samples) were estimated in each child annually. Results The children had a mean total cholesterol of 4.46 +/- 1.25 mmol/l ( +/- so) and a median triacylglycerol of 1.18 mmol/l (range 0.32-4.7), A tot al of 15.3% of the population had a total cholesterol > 5.2 mmol/l and 17.9 % had a triacylglycerol > 1.7 mmol/l; in 5.6% both total cholesterol and tr iacylglycerol were greater than these cut-off points. Total cholesterol, tr iacylglycerol and very low density lipoprotein-cholesterol were significant ly correlated to glycaemic control. However, total cholesterol was also sig nificantly related to parental total cholesterol either as analysed separat ely or as mean parental total cholesterol (p = 0.37, P = 0.0001), In stepwi se multiple regression analysis both mean parental total cholesterol (P = 0 .001) and HbA(1c) (P = 0.015) were significant determinants of the child's total cholesterol. The children studied were being followed prospectively f or the development of microalbuminuria and there was a weak association acr oss tertiles of total cholesterol, linking higher levels to the development of microalbuminuria (P < 0.05). Conclusions We conclude that both glycaemic control and familial factors ma y be important determinants of lipid levels in young people with diabetes. Both ma!: contribute to the subsequent risk of cardiovascular disease and p ossibly the development of incipient diabetic nephropathy.