Hypercholesterolemia and Lipid-Lowering Therapy in Children and Adolescents With Type 1 Diabetes: Do We Implement Current Guidelines?

Abstract

We investigated the prevalence of elevated LDL cholesterol in youth with type 1 diabetes (T1D), contributing factors, the frequency of lipid-lowering medication (LLM), and the achievement of target values. A cross-sectional analysis based on data from the Diabetes-Patienten-Verlaufsdokumentation registry (Diabetes Prospective Follow-up Registry) from 2013 to 2023. Inclusion criteria were T1D, age <18 years, and at least one documented LDL measurement. LDL cutoffs of >2.6, >3.4, and >4.1 mmol/L were defined. Application of national and international treatment guidelines was examined. Descriptive analyses and linear and logistic regression models were implemented using SAS 9.4. The study included 55,028 participants. Of these, 9.7% and 2.3% had LDL >3.4 mmol/L and >4.1 mmol/L, respectively. The parameters HbA1c (β = 1,142.7; P = 0.001), female sex (β = 861.5; P < 0.001), and BMI  >70th percentile (β = 520.1; P < 0.001) had the strongest effect on LDL levels. Only 7.3% of the cohort with elevated LDL levels received LLM. The majority (92.7%) with LDL >3.4 mmol/L and 87.0% with LDL >4.1 mmol/L were not treated. Estimated odds ratios (95% CI) for the use of LLM were 19.13 (15.4-23.7) for LDL >4.1 mmol/L; 3.1 (1.82-5.41) for ages 12-18 years; 2.31 (1.9-2.1) for diabetes duration of 5-10 years; 1.8 (1.5-2.1) for BMI  >70th percentile; 1.3 (1.0-1.6) for HbA1c >9%; and 1.18 (1.0-1.4) for female sex. However, only 15.7% of the treated patients (n = 707) reached the LDL target of <2.6 mmol/L, and LDL levels of 55% even remained at >3.4 mmol/L. We found a high prevalence of LDL hypercholesterolemia. The use of LLM was low, despite treatment indication, and treatment targets were mostly not achieved either due to underdosing or nonadherence to LLM. These findings confirm that dyslipidemia remains an underestimated cardiovascular risk factor in pediatric diabetology.