Endocrine Abstracts

Background: Poorly controlled diabetes is associated with dyslipidaemia including high cholesterol and LDL concentrations. This increases the long term risk of atherosclerosis and cardiovascular complications. In children and young people with type 1 diabetes, management with lipid lowering agents is controversial and to date long term evidence of benefit is limited. We report a case of severe dyslipidaemia and the impact of improvement in glycaemic control.

Case: A 15-year-old female with type 1 diabetes was referred to a tertiary metabolic unit for advice on management of extreme hyperlipidaemia. At annual review, 8 years after diagnosis, she was found to have a triglyceride concentration of 43.9 mmol/l and cholesterol that was unmeasurable as the sample was too lipaemic. There was a family history of obesity and her father had been prescribed lipid lowering medication from his GP. The patients’ weight was 55.8 kg with a BMI of 24.33. She was post pubertal and her HbA1c was 14.2%. The referring team commenced a bezafibrate, but this was not tolerated.

Initial management included intensive diabetes education with an improvement in HbA1c to 10.3% and a measurable cholesterol of 16 mmol/l. Insulin pump therapy resulted in further improvement (HbA1c 7.8%; cholesterol 6.7 mmol/l; triglycerides 1.96 mmol/l). 1 year following the start of insulin pump therapy, this improvement was sustained (Cholesterol 5.1 mmol/l; triglycerides 1.25 mmol/l). Molecular genetic testing was negative.

Discussion: This case of extreme dyslipidaemia in an adolescent with type 1 diabetes illustrates the close relationship between glycaemic control and lipid metabolism. Optimising the HbA1c will help identify individuals with dyslipidaemia who require further metabolic and molecular genetic assessment.