Úvod: Abnormality v metabolizme lipidov výrazne prispievajú k zvýšenému výskytu kardiovaskulárnych príhod u osôb s DM1T v porovnaní so zdravými jedincami. Porucha metabolizmu lipidov pri diabete 1. typu je výrazne závislá od udržiavania hodnoty glykémie blízko fyziologického rozmedzia. Štúdia DCCT potvrdila, že pacienti s dobre kompenzovaným DM1T majú podobné lipidové spektrum ako zdraví jedinci. Cieľ: Cieľom práce bolo preskúmať u 30 pacientov s DM1T s dobrou dlhodobou glykemickou kompenzáciou vzťahy parametrov lipidového profilu (cholesterol s vysokou hustotou HDL, cholesterol s nízkou hustotou LDL, celkový cholesterol – TC, triacylglyceroly – TAG) k veku, trvaniu DM1T, glykémii, HbA1c a k hodnotám krvného tlaku (TK), BMI korigovanému na vek (BMIc) a denným dávkam inzulínu na kg hmotnosti (DI) a tiež stanoviť matematické modely závislosti týchto parametrov od glykemickej kompenzácie, veku, trvania DM1T, krvného tlaku systolického a diastolického (sTK, resp. dTK), BMIc a DI. Výsledky: Hodnoty HbA1c boli signifikantne vyššie u diabetikov v porovnaní s kontrolami (p < 0,01), HDL boli vyššie u diabetikov ako u kontrol (rozdiel nie je signifikantný). LDL boli u diabetikov podobné ako u kontrol. TAG boli signifikantne nižšie u diabetikov ako u kontrol (p < 0,01). HDL signifikantne pozitívne koreluje s HbA1c (r = 0,372; p < 0,05), negatívne s sTK (r = –0,373, p < 0,05), TAG s vekom (r = 0,546, p < 0,01), trvaním DM1T (r = 0,577, p < 0,001) a s sTK (r = 0,407, p < 0,05). Našli sme tiež štatisticky vhodné matematické modely vzťahu HDL a TAG so sledovanými parametrami: vek, trvanie DM1T, glykémia, HbA1c, TK, BMIc, DI (r = 0,785; r2 = 0,616; p < 0,01; resp. r = 0,758; r2 = 0,574; p < 0,05). Záver: Na zmeny v hodnotách HDL a TAG u mladých diabetikov má významný vplyv najmä dlhodobá glykemická kompenzácia a inzulínová terapia.

Introduction: Abnormalities in lipid metabolism contribute significantly to the increased occurrence of cardiovascular events in individuals with T1DM compared to healthy subjects. Disorder of lipid metabolism in T1DM is heavily dependent on maintaining of blood glucose values near the physiological range. DCCT study confirmed that patients with well compensated diabetes have similar lipid spectrum to the healthy subjects one. Aims: We aimed to study relations of lipid profile parameters (cholesterol of high density HDL, cholesterol of low density LDL, total cholesterol - TC, triglycerides - TAG) to age, duration of T1DM (DD), blood glucose, HbA1c and if the blood pressure (BP), BMI corrected for age (BMIc) and daily insulin doses per kilogram (DI) in 30 patients with T1DM with good long-term glycemic compensation. We aimed also to find mathematical models of lipid profile parameters dependence of the parameters of glycemic control, age, duration of DM1T, blood pressure (systolic and diastolic BPs, BPd, respectively) BMIc and DI. Results: HbA1c levels were significantly higher in diabetic patients compared to controls (p < 0.01), HDL were higher in diabetics than in controls (not significantly). LDL levels were in diabetics similar to controls. TAG was significantly lower in diabetics than in controls (p < 0.01). HDL significantly positively correlated with HbA1c (r = 0.372, p < 0.05) and negatively with BPs (r = -0.373, p < 0.05), TAG correlated with age (r = 0.546, p < 0.01), DD (r = 0.577, p < 0.001) and BPs (r = 0.407, p < 0.05). We also found a statistically appropriate mathematical models of the relationship of HDL and TAG with the parameters: age, DD, glucose, HbA1c, BP, BMIc, DI (r = 0.785, r2 = 0.616, p < 0.01, R = 0.758; r2 = 0.574, p < 0.05, respectively). Conclusion: The changes in HDL and TAG values in juvenile diabetics are significantly affected by particularly long-term glycemic control and insulin therapy.

1 detská klinika Lekárskej fakulty UK a DFNsP Bratislava

Impact of long-term glycemic control on changes of lipid profile in children and adolescents with 1 type diabetes mellitus

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