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[Lipid disorders in children with insulin-dependent diabetes mellitus]
1Unidade de Endocrinologia, Hospital Curry Cabral, Lisboa.
Insights
Lipid disorders are common in diabetic children, even with good glycemic control. Measuring specific apolipoproteins (Apo AI, Apo B100, Apo CIII) can indicate glycemic control and cardiovascular risk.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Cardiovascular Risk Assessment
Context:
- Lipid and lipoprotein disorders are prevalent in insulin-dependent diabetes, significantly increasing cardiovascular risk.
- Early metabolic changes are observed in diabetic children, often exacerbated by poor glycemic control.
- Abnormalities persist even in diabetic children with well-managed blood sugar levels.
Purpose:
- To investigate the relationship between glycemic control and lipid metabolism abnormalities in diabetic children.
- To identify reliable indicators of glycemic control and cardiovascular risk in pediatric diabetes.
Summary:
- Hyperglycemia drives lipid changes by increasing hepatic triglyceride synthesis and promoting lipoprotein glycosylation/oxidation.
- Insulin deficiency contributes to lipid abnormalities through decreased lipoprotein lipase activity.
- Key abnormalities include elevated triglycerides, VLDL-Tg, LDL-Tg, VLDL-Cholesterol, Apo B, Apo CIII, and reduced HDL-Cholesterol, Apo AI.
Impact:
- Apo AI, Apo B100, and Apo CIII measurements serve as reliable indicators of glycemic control in diabetic children.
- These apolipoprotein levels are valuable predictors of future cardiovascular risk in adult patients.
- Standard diabetes management may not fully resolve all lipid disorders, highlighting the need for targeted monitoring.
Abstract:
Lipid and lipoprotein disorders are frequently detected in insulin dependent diabetics, which predisposes the high cardiovascular risk present in these patients. Studies performed with insulin dependent children showed early changes in lipid metabolism, usually correlated and aggravated by poor glycemic control. However, there are abnormalities present even in diabetic children with good glycemic control. The usual measures used to improve diabetic control are not sufficient to correct all the lipid disorders in Diabetes Mellitus. Hyperglycemia is the major factor, inducing metabolic lipid changes by increasing hepatic synthesis of triglycerides and promoting lipoprotein and apolipoprotein glycosylation and oxidation. Other changes, associated with the decrease of lipoprotein lipase activity are directly related to insulin deficiency. The lipid profile in children with poor diabetic control is similar to that already described for adult patients. The main abnormalities found are: increased levels of triglycerides, VLDL-Tg, LDL-Tg, VLDL-Cholesterol, Apo B and Apo CIII, with decreased values of HDL-Cholesterol and Apo AI. As there is a strong correlation between control and the degree of lipid changes, even with normal levels of cholesterol and triglycerides, measurements of Apo AI, Apo B100 and Apo CIII seem to be good and reliable indicators of glycemic control in diabetic children, and a factor with high predictive value for the evaluation of cardiovascular risk in adult patients.