Dyslipidemia in Pediatric Type 2 Diabetes Mellitus
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PEDIATRIC TYPE 2 AND MONOGENIC DIABETES (O PINHAS-HAMIEL, SECTION EDITOR)
Dyslipidemia in Pediatric Type 2 Diabetes Mellitus Bhuvana Sunil 1 & Ambika P. Ashraf 1
# The Author(s) 2020
Abstract Purpose of Review Cardiovascular (CV) disease is a major cause of mortality in type 2 diabetes mellitus (T2D). Dyslipidemia is prevalent in children with T2D and is a known risk factor for CVD. In this review, we critically examine the epidemiology, pathophysiology, and recommendations for dyslipidemia management in pediatric T2D. Recent Findings Dyslipidemia is multifactorial and related to poor glycemic control, insulin resistance, inflammation, and genetic susceptibility. Current guidelines recommend lipid screening after achieving glycemic control and annually thereafter. The desired lipid goals are low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, high-density lipoprotein cholesterol (HDL-C) > 35 mg/dL, and triglycerides (TG) < 150 mg/dL. Summary If LDL-C remains > 130 mg/dL after 6 months, statins are recommended with a treatment goal of < 100 mg/dL. If fasting TG are > 400 mg/dL or non-fasting TG are > 1000 mg/dL, fibrates are recommended. Although abnormal levels of atherogenic TG-rich lipoproteins, apolipoprotein B, and non-HDL-C are commonly present in pediatric T2D, their measurement is not currently considered in risk assessment or management. Keywords Dyslipidemia . Insulin resistance . Type 2 diabetes . Cardiovascular risk . Pediatric
Introduction Dyslipidemia is highly prevalent in children and adolescents with type 2 diabetes mellitus (T2D). Prominent risk factors including obesity, insulin resistance (IR), hypertension, and sedentary lifestyle tend to cluster in at-risk children. As T2D is an important independent cardiovascular (CV) risk factor, it is essential to recognize and manage dyslipidemia to prevent the anticipated CV morbidity. The typical dyslipidemia pattern in T2D includes elevated serum triglycerides (TG), decreased high-density lipoprotein cholesterol (HDL-C), and, occasionally, elevated low-density lipoprotein cholesterol (LDL-C) levels [1]. The other less commonly evaluated, non-conventional lipoprotein abnormalities include elevated very low-density lipoprotein
This article is part of the Topical Collection on Pediatric Type 2 and Monogenic Diabetes * Ambika P. Ashraf [email protected] 1
Department of Pediatrics, Division of Endocrinology and Diabetes, University of Alabama at Birmingham, CPPII M30, 1601 4th Ave S, Birmingham, AL 35233, USA
cholesterol (VLDL-C), non-HDL-C, small, dense LDL-C, and apolipoprotein B100 (apo B) concentrations [2–5].
Pathophysiology and Patterns of Dyslipidemia in Type 2 Diabetes Insulin regulates lipid metabolism and cholesterol homeostasis. Concurrent obesity, metabolic syndrome, and hyperglycemia further worsen the dysregulated lipid metabolism in children and adolescents with T2D. In this section, we review the relevant lipid and lipoprotein abnormalities.
Dysregulated Triglyceride Metabolism Circulating TGs are a mixture of TG-rich lipopro
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