Abstract
ImportanceRisk factors for atherosclerotic cardiovascular disease (ASCVD) are well established in type 2 diabetes (T2D), but not in type 1 diabetes (T1D). The impact of partial clinical remission (PR) on short-term ASCVD risk in T1D is unclear.AimTo investigate the impact of PR on the earliest ASCVD risk phenotype in adult T1D using factor analysis to compare the lipid phenotypes of T1D, T2D and controls after stratifying the T1D cohort into remitters and non-remitters.Subjects and MethodsA study of 203 adults subjects consisting of 86 T2D subjects, and 77 T1D subjects stratified into remitters (n=49), and non-remitters (n=28). PR was defined as insulin-dose adjusted HbA1c of ≤9, and obesity as a BMI ≥30 kg/m2. Factor analysis was used to stratify the groups by ASCVD risk by factorizing seven lipid parameters (TC, LDL, HDL, non-HDL, TC/HDL, TG, TG/HDL) into 2 orthogonal factors (factor 1: TC*LDL; factor 2: HDL*TG) that explained 90% of the variance in the original seven parameters.ResultsThe analysis of individual lipid parameters showed that TC/HDL was similar between the controls and remitters (p=NS) but was significantly higher in the non-remitters compared to the remitters (p=0.026). TG/HDL was equally similar between the controls and remitters (p=NS) but was lower in the remitters compared to the non-remitters (p=0.007). TG was significantly lower in the remitters compared to T2D subjects (p<0.0001) but was similar between T2D subjects and non-remitters (p=NS). Non-HDL was significantly lower in the controls versus non-remitters (p=0.0003) but was similar between the controls and remitters (p=NS). Factor analysis showed that the means of factor 1 and factor 2 composite scores for dyslipidemia increased linearly from the controls, remitters, non-remitters to T2D, p value 0.0042 for factor 1, and <0.0001 for factor 2, with remitters having similar lipid phenotype as controls, while non-remitters were similar to T2D.ConclusionsPartial clinical remission of T1D is associated with a favorable early lipid phenotype which could translate to reduced long-term CVD risk in adults.
Highlights
Diabetes mellitus affects 34.2 million Americans, or 10.5% of the population [1], and atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in individuals with diabetes [1]
The analysis of individual lipid parameters showed that total cholesterol/HDL cholesterol (TC/HDL) was similar between the controls and remitters (p=NS) but was significantly higher in the non-remitters compared to the remitters (p=0.026)
Factor analysis showed that the means of factor 1 and factor 2 composite scores for dyslipidemia increased linearly from the controls, remitters, non-remitters to type 2 diabetes (T2D), p value 0.0042 for factor 1, and
Summary
Diabetes mellitus affects 34.2 million Americans, or 10.5% of the population [1], and atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in individuals with diabetes [1]. Risk factors for ASCVD are well established in type 2 diabetes (T2D), but not in type 1 diabetes (T1D) [1], and the impact of partial clinical remission (PR) on long-term ASCVD in T1D is unclear. Elevated nonHDL-C correlates with 99% increased CVD risk for patients with T2D [3] where the classic lipid abnormalities are characterized by elevated TG, small dense LDL-C, and low HDL-C [4]. Despite the establishment of the correlation between ASCVD and diabetes, the underlying mechanisms remain poorly understood [6], especially in T1D where 50% of the subjects undergo partial clinical remission (PR) or honeymoon phase following the diagnosis of T1D [7]. PR usually lasts for 3-12 months [8], but could be longer [9]
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