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Longitudinal study of lipoprotein(a) in peripubertal children with insulin-dependent diabetes
J J Couper1, R Cocciolone, D J Bates
1Department of Endocrinology, Women's and Children's Hospital, Adelaide, South Australia.
Insights
In children with insulin-dependent diabetes, lipoprotein(a) levels significantly decreased over time. This reduction in lipoprotein(a) was not associated with changes in metabolic control, albumin excretion, or puberty.
Area of Science:
- Pediatrics
- Endocrinology
- Cardiovascular Research
Background:
- Lipoprotein(a) is a risk factor for cardiovascular disease.
- Understanding its changes in pediatric diabetes is crucial for long-term health outcomes.
- Peripubertal changes in metabolic markers and cardiovascular risk factors require investigation.
Purpose of the Study:
- To investigate the longitudinal relationship between lipoprotein(a) and key metabolic and developmental markers in children with insulin-dependent diabetes.
- To assess how changes in hemoglobin A1c, albumin excretion rate, and pubertal status influence lipoprotein(a) levels over time.
Main Methods:
- Prospective follow-up of 114 peripubertal children with insulin-dependent diabetes for approximately 15 months.
- Measurement of lipoprotein(a), apolipoproteinB-100, hemoglobin A1c, albumin excretion rate, and Tanner stage at baseline and end of study.
- Nephelometry used for lipoprotein(a) and apolipoproteinB-100 assays, validated against radioimmunoassay.
Main Results:
- Lipoprotein(a) levels significantly decreased over the study period (p < 0.001).
- ApolipoproteinB-100 levels remained unchanged.
- Changes in lipoprotein(a) did not correlate with changes in hemoglobin A1c, albumin excretion rate, Tanner stage, or insulin dose.
- Significant decrease in lipoprotein(a) was observed independently of metabolic control and albuminuria changes in subgroup analyses.
Conclusions:
- Longitudinal changes in lipoprotein(a) in peripubertal children with insulin-dependent diabetes are not linked to metabolic control or early signs of albuminuria.
- Further research is needed to elucidate the factors driving lipoprotein(a) reduction in this population.
Abstract:
We aimed to examine the longitudinal relationship between lipoprotein(a) and haemoglobin A1c, albumin excretion rate, and puberty in peripubertal children with insulin-dependent diabetes. A total of 114 patients aged 11.5 +/- 3.6 years (mean (SD)) were followed prospectively for 15.2 +/- 2.8 months. Lipoprotein(a), apolipoproteinB-100, haemoglobin A1c, mean overnight albumin excretion rate and Tanner stage were determined at the beginning and end of the study period. Lipoprotein(a) and apolipoproteinB-100 were measured using nephelometry. This method was correlated with radioimmunoassay and there was no significant change in mean bias during the study. Lipoprotein(a) fell significantly over time (214, (152, 276); 160 (84, 236) mg l-1 geometric mean (0.95 confidence intervals), p < 0.001); apolipoproteinB-100 did not change. Lipoprotein(a) and apolipoproteinB-100 did not differ in 233 cross-sectional controls of similar age. The change in lipoprotein(a) did not correlate with a small fall in haemoglobin A1c or with overnight albumin excretion rate, Tanner stage or insulin dose. Separate analysis of male and female patients and prepubertal and pubertal patients continued to show a significant fall in lipoprotein(a) independent of change in haemoglobin A1c or albumin excretion rate. Likewise, 53 patients with a change in haemoglobin A1c of greater than 1%, and 20 patients who progressed from normal albumin excretion rate to albumin excretion rate above the 95th centile, showed no relationship between lipoprotein(a) and haemoglobin A1c or albumin excretion rate. In conclusion, longitudinal changes in lipoprotein(a) do not relate to metabolic control or early changes in albuminuria in young patients with insulin-dependent diabetes.
