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The SEARCH for Diabetes in Youth Study

Diana B. Petitti, MD, MPH; Giuseppina Imperatore, MD, PhD; Shana L. Palla, MS; Stephen R. Daniels, MD, PhD; Lawrence M. Dolan, MD; Ann K. Kershnar, MD; Santica Marcovina, PhD, ScD; David J. Pettitt, MD; Catherine Pihoker, MD; for the SEARCH for Diabetes in Youth Study Group

Arch Pediatr Adolesc Med. 2007;161(2):159-165.

Objective  To assess the relationship of serum lipid concentrations with glucose control in youth with diabetes mellitus.

Design  Cross-sectional analyses of data from the SEARCH for Diabetes in Youth study.

Setting  Multicenter study of youth with diabetes onset at younger than 20 years.

Patients/Participants  Nineteen hundred seventy-three SEARCH participants aged 10 years or older with hemoglobin A_1c and fasting total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride measured at the SEARCH study examination.

Main Exposure  Hemoglobin A_1c.

Outcome Measure  Lipid concentrations.

Results  There were significant trends of higher levels of TC, LDL-C, triglyceride, and non–HDL-C (but not HDL-C) with higher hemoglobin A_1c concentrations for both diabetes types. The slopes of TC increase were 7.8 mg/dL (0.20 mmol/L) per unit increase in hemoglobin A_1c for type 1 and 8.1 mg/dL (0.21 mmol/L) for type 2. Levels of TC, LDL-C, triglyceride, and non–HDL-C were all significantly higher (all P values <.001) in type 2 than in type 1 diabetes (mean differences in milligrams per deciliter [millimoles per liter], +13.6 [+0.35] for TC; +8.3 [+0.22] for LDL-C; +66.3 [+0.75] for triglyceride; +25.5 [+0.66] for non–HDL-C). Levels of HDL-C were lower in youth with type 2 diabetes (mean difference, –11.9 mg/dL [–0.31 mmol/L]). Among those with type 1 diabetes in poor glycemic control, 35%, 27%, and 12% had high concentrations of TC (200 mg/dL [5.17 mmol/L]), LDL-C (130 mg/dL [3.36 mmol/L]), and triglyceride (200 mg/dL [2.26 mmol/L]), respectively. In youth with type 2 diabetes in poor glycemic control, percentages with high levels of TC, LDL-C, and triglycerides were 65%, 43%, and 40%, respectively.

Conclusions  Glycemic control and lipid levels are independently associated in youth with both type 1 and type 2 diabetes.

Author Affiliations: Kaiser Permanente Southern California, Pasadena (Drs Petitti, Kershnar, and Pettitt); Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Imperatore); Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (Ms Palla); Children's Hospital Medical Center, Cincinnati, Ohio (Drs Daniels and Dolan); Northwest Research Laboratory, Seattle, Wash (Dr Marcovina); Children's Hospital and Regional Medical Center, Seattle (Dr Pihoker).

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