Introduction: Evidence is currently limited regarding the management of abnormal lipid profiles in children and young people (CYP) with Type 1 Diabetes Mellitus (T1DM). ISPAD recommend monitoring every five years and statin use to maintain LDL cholesterol <3.4 mmol/L1. Guidance is specific to LDL. NICE guidelines do no recommend routine screening for CYP with T1DM.
Methodology: We reviewed all lipid profiles (including cholesterol, triglycerides, LDL and HDL) performed in our population of CYP with T1DM over 12 months. We recorded the results and management of these lipid profiles.
Results: 351 patients had their lipid profiles checked as part of their annual review process. 108 patients had an abnormal profile. 47 patients had a high LDL (>2.85 mmol/l). 30 patients had their lipid profiles repeated when fasted. The results of these are shown in Table 1.
47 patients required additional dietetic and lifestyle interventions to further tighten their diabetes control. 7 patients fit the criteria for consideration for statins.
|Number of patients|
|Sample not repeated||13|
|LDL improved to within the normal range (<2.85 mmol/l)||5|
|LDL improved to <3.3 mmol/l but remained >2.85 mmol/l||5|
|LDL remained >3.3 mmol/l||7|
|LDL remained >4||1|
Conclusion: There is limited evidence regarding the use of statins in CYP with T1DM. 2% of our population fit the criteria for consideration of statins whilst 14% have a raised LDL requiring more intensive management of their diabetes, diet and exercise. Other parameter abnormalities, including raised triglycerides and cholesterol and reduced HDL, are common affecting 31% of our population. There is even less evidence relating to the outcomes associated with these abnormalities. NICE suggest using a cardiovascular risk assessment in adults before performing lipid profiles and treating with statins2. There is no guidance for CYP with T1DM. We suggest that further prospective studies are required to address these issues and further our knowledge of lipid abnormalities in CYP with T1DM.
References: 1. ISPAD guidelines, Microvascular and macrovascular complications in children and adolescents Donaghue et al. 2018.
2. NICE Cardiovascular disease: risk assessment and reduction, including lipid modification (CG181) 2016.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes