Endocrine Abstracts (2016) 45 OC7.1 | DOI: 10.1530/endoabs.45.OC7.1

Hypercholesterolaemia screening in type 1 diabetes - a difference of opinion

Toby Candler1,2, Osama Mahmoud2, Julie Edge3 & Julian Hamilton-Shield1,2

1Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, UK; 2Biomedical Research unit in Nutrition, Diet and Lifestyle, School of Oral and Dental Sciences, University of Bristol, Bristol, UK; 3Oxford Children’s Hospital, Headington, Oxford, UK.

Background: The National Institute for Health and Care Excellence (NICE) guidelines on childhood type 1 diabetes (T1D) do not recommend cholesterol screening. However, the National Paediatric Diabetes Audit (NPDA) has an annual cholesterol measure (>12 years) as a key outcome indicator. This is confusing for professionals managing children with T1D.

Methods: An online survey was sent to 280 members of the Association of Children’s Diabetes Clinicians assessing cholesterol screening practice.

Results: About 87 (31%) responded. About 94% measure cholesterol in their patients. About 33% annually on all patients, 40% using annual measurements only in the over 12-year-old population. About 7% routinely using fasting samples and 41% use only a non-fasting sample. In addition to total cholesterol, 67% also measure triglycerides, HDL and LDL cholesterol levels. About 63% used no guidelines to decide treatment/further investigation. NICE guidelines and ISPAD (International Society for Paediatric and Adolescent Diabetes) were the most commonly used. A ‘high’ cholesterol varied from >4.5 to >8 mmol/l, with 40% giving no response or specific level. Action following a cholesterol level that was above the threshold for treatment included 42% who would refer to a dietician, 14% who would refer to a lipidologist and 2% who would commence a statin. About 16% would refer to a dietician and a lipidologist. About 10% would refer to a dietician and commence a statin. About 3% would refer to a lipidologist and dietician as well as commence a statin. About 13% of professionals would not take any further action. Only 14% of clinicians had started statin therapy in their diabetes clinic in previous 5 years.

Conclusion: Whilst the majority measure cholesterol in children with T1D, there is marked variability in sampling, patients screened and action taken if considered abnormal. It is debatable whether cholesterol measures should be undertaken, certainly more than once and whether it should feature as key outcome in the national audit in future.

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