Cardiovascular risk factor management remains an important component of care in youth with type 1 diabetes mellitus (T1DM). A cross-sectional registry analysis published in Diabetes Care found frequent low-density lipoprotein (LDL) hypercholesterolemia, low use of lipid-lowering medication (LLM), and limited achievement of recommended LDL targets in pediatric patients with T1DM.

The analysis used data from the Diabetes-Patienten-Verlaufsdokumentation registry (Diabetes Prospective Follow-up Registry) collected between 2013 and 2023. Eligible participants had T1D, were younger than 18 years, and had at least one documented LDL measurement. LDL thresholds of >2.6, >3.4, and >4.1 mmol/L were assessed. Descriptive analyses and linear and logistic regression models were performed.

Among 55,028 participants, 9.7% had LDL levels >3.4 mmol/L and 2.3% had LDL levels >4.1 mmol/L. Higher glycated hemoglobin (HbA1c), female sex, and body mass index above the 70th percentile showed the strongest associations with higher LDL levels. Estimated odds ratios for LLM use were highest for LDL >4.1 mmol/L (19.13; 95% CI 15.4-23.7), followed by age 12 to 18 years, longer diabetes duration, higher BMI percentile, HbA1c >9%, and female sex.

Despite these findings, only 7.3% of patients with elevated LDL received LLM. Most participants with LDL >3.4 mmol/L (92.7%) and >4.1 mmol/L (87.0%) were untreated. Among treated patients (n=707), only 15.7% achieved LDL <2.6 mmol/L, while 55% remained >3.4 mmol/L.

The findings indicate that dyslipidemia remains an underrecognized cardiovascular risk factor in pediatric diabetology, with substantial gaps in treatment use and LDL target attainment.