Visual Abstract
Higher HbA1c is associated with worse average lipid trajectory in T1D. It is unknown if there is heterogeneity in this association. Thus we assessed the 30-yr association between HbA1c and both Non-HDLc and HDLc in a T1D cohort, examining varying longitudinal patterns in association with mortality. Data are from the Pittsburgh Epidemiology of Diabetes Complications study (n=658, 51% male, baseline mean age 27 yrs, T1D duration 19 yrs). Longitudinal associations between HbA1c and Non-HDLc were assessed in mixed models. The same analysis was performed for HDLc separately by sex. Group based multi-trajectory models identified simultaneous trajectories of HbA1c and each lipid. Over 30 yr each 1% higher HbA1c was associated with 6.6±0.4 mg/dl greater Non-HDLc (p<0.001). There was no association between HbA1c and HDLc (men: p=0.72, women: p=0.76). Five HbA1c - Non-HDLc combined groups were identified (Figure 1). Group 1 had the best HbA1c and Non-HDLc trajectories. Group 2 had an unexpected combination of high HbA1c but normal Non-HDLc and was characterized by better baseline systolic blood pressure (p=0.03) and estimated glomerular filtration rate (p<0.001) compared to Group 1. Group 2 had moderately elevated total and cardiovascular (CVD) mortality, but not end-stage renal disease (ESRD) mortality. These results suggest there is a subgroup with T1D who, despite high HbA1c, is at relatively low renal risk, perhaps related to good Non-HDLc.
R. G. Miller: None. T. J. Orchard: None. T. Costacou: None.
American Diabetes Association (1-19-JDF-109 to R.G.M.); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK034818)
