Dyslipidemia in children with type 2 diabetes vs. obesity

To compare the frequency and severity of dyslipidemia between subjects with type 2 diabetes (T2DM) and non-diabetic obese group (OB) subjects, followed in a pediatric subspecialty clinic.

One hundred and four OB subjects seen consecutively by one physician and 67 pediatric subjects diagnosed with T2DM (negative antibodies) were screened from an institutional review board-approved database. Fifty-two T2DM and 75 OB subjects with fasting lipid profiles measured at one hospital's laboratory were included.

Both OB and T2DM subjects were predominantly Mexican American. Comparing T2DM at diagnosis or uncontrolled (UC) and OB, mean +/- SD age was 14.3 +/- 2.3 and 11.4 +/- 3.7 with body mass index-Z score of 2.02 +/- 0.67 and 2.46 +/- 0.45, respectively (both p < 0.01). Comparing lipid levels in T2DM to OB and National Health and Nutrition Examination Survey III, the percentage of subjects, respectively, with cholesterol >200 mg/dL (5.17 mmol/L) were 55.8, 22.7, and 10%; with low-density lipoprotein >130 mg/dL (3.36 mmol/L) were 39.4, 12.5, and 10%; with triglycerides >150 mg/dL (1.68 mmol/L) were 65.1, 38.7, and 12.5%; and with high-density lipoprotein <35 mg/dL (0.91 mmol/L) were 40, 22.2, and 10%. Over 80% of the T2DM subjects improved their lipid profile with improved glycemic control as hemoglobin A1c decreased from 10.85 +/- 2.17 to 7.6 +/- 2%.

Dyslipidemia is a frequent comorbidity of obesity and T2DM, starting in childhood, and poses a major public health risk. Dyslipidemia in pediatric subjects with UC T2DM is significantly worse than in OB subjects but is similar to OB subjects when diabetes was better controlled. Earlier use of lipid-lowering drugs should be considered in pediatric T2DM patients who achieve tight glycemic control, yet their dyslipidemia persists.