Dyslipidemia is an important cardiovascular risk factor in young people with type 1 diabetes mellitus (T1DM). A cross-sectional registry analysis published in Diabetes Care assessed the prevalence of elevated low-density lipoprotein (LDL) cholesterol, factors influencing LDL levels, the use of lipid-lowering medication (LLM), and achievement of LDL treatment targets in youths with T1DM.
The analysis used data from the Diabetes-Patienten-Verlaufsdokumentation (Diabetes Prospective Follow-up Registry) collected between 2013 and 2023. Eligible participants had T1DM, were younger than 18 years, and had at least one documented LDL measurement. LDL cutoffs of >2.6 mmol/L, >3.4 mmol/L, and >4.1 mmol/L were defined. Descriptive analyses and linear and logistic regression models were conducted using SAS version 9.4.
A total of 55,028 participants were included in the analysis. Elevated LDL cholesterol levels were observed in a notable proportion of the cohort. LDL levels above 3.4 mmol/L were present in 9.7% of participants, while 2.3% had LDL levels above 4.1 mmol/L. Regression analyses showed that HbA1c (β = 1,142.7; P = 0.001), female sex (β = 861.5; P < 0.001), and body mass index (BMI) above the 70th percentile (β = 520.1; P < 0.001) had the strongest effects on LDL levels.
Despite the presence of elevated LDL levels, lipid-lowering therapy was used infrequently. Only 7.3% of youths with elevated LDL levels received lipid-lowering medication. The majority of patients with LDL >3.4 mmol/L (92.7%) and those with LDL >4.1 mmol/L (87.0%) were not treated. Logistic regression analyses showed higher odds of receiving lipid-lowering therapy for LDL >4.1 mmol/L (odds ratio [OR] 19.13; 95% CI 15.4-23.7), age 12-18 years (OR 3.1; 95% CI 1.82–5.41), diabetes duration of 5-10 years (OR 2.31; 95% CI 1.9-2.1), BMI above the 70th percentile (OR 1.8; 95% CI 1.5-2.1), HbA1c >9% (OR 1.3; 95% CI 1.0-1.6), and female sex (OR 1.18; 95% CI 1.0-1.4).
Among treated patients (n = 707), LDL targets were achieved in a minority. Only 15.7% reached the LDL goal of <2.6 mmol/L. In addition, 55% of treated individuals continued to have LDL levels above 3.4 mmol/L. The findings indicate a high prevalence of LDL hypercholesterolemia and limited achievement of recommended LDL targets in youths with T1DM. The analysis also noted low use of lipid-lowering medication despite treatment indications, suggesting underdosing or nonadherence as possible contributing factors.
