G572(P) What do we do with lipid levels measured as part of the national paediatric diabetes audit?

Abstract

Aims Macrovascular complications of diabetes are seen prematurely in adulthood, but screening for risk factors in childhood (lipids, blood pressure and obesity) may prevent future adverse outcomes. The National Paediatric Diabetes Audit requires their measurement but only blood pressure and BMI contribute to key care processes. The current NICE (2016) guidance on childhood type 1 diabetes does not require lipid screening and has no specific advice on dyslipidaemia. Method We analysed lipid data obtained for those 12–19 years old children and young people (CYP) under care of our diabetes service over a 4.5 years period from January 2014 to July 2018. 348 sets of results representing 160 patients were included. Results Using published ‘normal’ total cholesterol values of up to 4 mmol/L, we found 66% of CYP exceeded this value, 23.1% had cholesterol levels above 5 mmol/L. 9 CYP (5%) had values above 6 mmol/L, raising the possibility of additional familial hypercholesterolaemia (FH). For those 106 CYP with a Cholesterol>4 mmol/L (106 patients) there was no correlation between cholesterol and HbA1c or BMI. For those CYP with a Cholesterol >6 mmol/L and high Triglycerides (6 patients) dyslipidaemia this appeared related to poorly controlled diabetes (High HbA1C) or weight (High BMI for Age), the latter potentially related to insulin resistance. There were 3 CYP with serum Cholesterol >6 mmol/L, normal Triglycerides, high LDL., one of whom probably has Familial Hypercholesterolaemia, and had very high HDL cholesterol levels possibly linked to Familial Hyperalphalipoproteinaemia. Conclusions Analysis of the data determined a significant number of CYP with diabetes have established lipid abnormalities, which are not being actively treated. There are currently no clear guidelines for managing paediatric dyslipidaemia. Pharmacological management in childhood is controversial, and recommended management is lifestyle modification by diet and exercise although data on the benefits in CYP is lacking. The impact of statins on surrogate measures of macrovascular complications in CYP with Type 1 diabetes is contentious. The potential of concomitant FH requiring consideration of statin therapy post puberty would be in line with national guidance and requires a detailed family history.