Outstanding improvement of the advanced lipoprotein profile in subjects with new-onset type 1 diabetes mellitus after achieving optimal glycemic control

Esmeralda Castelblanco,Marta Hernández,Emilio Ortega,Núria Amigó,Jordi Real,Minerva Granado-Casas,Inka Miñambres,Carolina López,Albert Lecube,Marcelino Bermúdez-López,Núria Alonso,Josep Julve,Didac Mauricio

doi:10.1016/j.diabres.2021.109145

Abstract

AimsThe impact of glycemic optimization on lipoprotein subfraction parameters in apparently normolipidemic subjects with new-onset type 1 diabetes mellitus (T1D) was examined. MethodsWe evaluated the serum lipid and advanced lipoprotein profiles in twenty subjects at onset of T1D and twenty non-diabetic controls by laboratory methods and 1H NMR spectroscopy shortly after diabetes diagnosis (baseline), and after achieving optimal glycemic control (HbA1c ≤ 7.0%). ResultsAdvanced lipoprotein analysis revealed a significant reduction from baseline in serum concentrations of triglycerides (TG), cholesterol (C), and apolipoprotein (Apo)B-containing lipoproteins of treated subjects (VLDL-TG: −21%, IDL-TG: −30%, LDL-TG: −34%, LDL-TG: −36%, P < 0.05; VLDL-C: –23%, IDL-C: −44%, LDL-C: −16%; p < 0.05). Decreased VLDL and LDL lipids were mainly attributed to concomitant reductions in the concentration of medium-sized VLDL (–36%) and medium-sized LDL (–31%) and, to a lesser extent, to large-sized LDL (–14%). Notably, proatherogenic IDL characteristics and related surrogates of atherogenicity were resolved upon achievement of optimal glycemic status. Moreover, the concentration of HDL-TG was also reduced (−18%) at follow-up. ConclusionsOur data showed that the achievement of optimal glycemic control after T1D onset corrected hidden derangements in ApoB-containing lipoproteins (particularly IDL) and HDL-TG that are related to higher cardiovascular risk in poorly controlled T1D.

Highlights

An altered lipoprotein profile is often hidden in normolipidemic subjects with uncontrolled type 1 diabetes mellitus (T1D)
In otherwise normolipidemic T1D subjects according to the conventional lipid profile, the achievement of optimal glycemic control after diabetes onset is associated with normalization of profound derangements in ApoB-containing lipoproteins (VLDL, intermediate-density lipoproteins (IDL), and LDL)
Whether higher cardiovascular risk in poorly controlled T1D is partially mediated by these proatherogenic lipid alterations should be elucidated by further studies

Summary

Introduction

An altered lipoprotein profile is often hidden in normolipidemic subjects with uncontrolled type 1 diabetes mellitus (T1D). The contribution of other hidden additional risk factors further elevates CVD risk in a synergistic manner in T1D [2], and their management has been prioritized in recent updates of the American Diabetes Association (ADA) and the European Association (EASD) recommendations [3, 4]. In this regard, accumulating evidence suggests that glycemic control has been strongly associated with improved CVD outcomes in T1D [2, 5, 6]. HDL-C values may be normal or even moderately elevated in T1D subjects [11, 14, 15], but HDL in diabetes may display poorer antiatherogenic properties [16, 17], due at least in part to the cumulative associated glycoxidative modifications of HDL proteins [14]

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Results

Conclusion