Joint 30-year HbA1c and lipid trajectories and mortality in type 1 diabetes. (March 2022)

• Record Type: Journal Article
• Authors: Miller, Rachel G.; Orchard, Trevor J.; Costacou, Tina
• Is Part Of: Diabetes research and clinical practice. Volume 185(2022)
• Publication Date: 2022-03
• Subjects: Type 1 diabetes -- HbA1c -- Glycemic control -- Lipids -- Cholesterol -- Heterogeneity -- Mortality; CVD cardiovascular disease -- DKD diabetic kidney disease -- eGDR estimated glucose disposal rate; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2022.109787
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Aims: Higher HbA1c has been associated with dyslipidemia in type 1 diabetes, but it is unknown whether there is heterogeneity in this association. Thus we assessed the longitudinal association between HbA1c and lipids over 30 years in a type 1 diabetes cohort and examined whether variation in such longitudinal patterns was associated with total and cause-specific mortality. Methods: Data were from the Pittsburgh Epidemiology of Diabetes Complications study (n = 581 with ≥2 visits, 51% male, baseline mean age 27, diabetes duration 19 years). Longitudinal associations between HbA1c and lipids were assessed in mixed models. Group-based multi-trajectory models identified simultaneous trajectories of HbA1c and lipids. Results: Longitudinal HbA1c was associated with Non-HDLc (p < 0.0001) and triglycerides (p < 0.0001), but not HDLc (men: p = 0.72, women: p = 0.76). There was heterogeneity in the HbA1c-Non-HDLc association only, with five HbA1c-Non-HDLc groups identified. One group (20%) had an unexpected combination of high HbA1c but normal Non-HDLc and had only moderately increased cardiovascular mortality (rate ratio [RR] = 2.80, 95% CI 1.31–6.00) and kidney disease mortality (RR = 2.30, 95% CI 0.97–5.50) compared to Low HbA1c-Normal Non-HDLc. Conclusions: These results suggest there is a subgroup with type 1 diabetes who, despite poor glycemic control, has a relatively good prognosis, perhaps related to good Non-HDLc.