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New study by Benjamin Nwosu examines cholesterol at puberty in type 1 diabetes

Pediatric endocrinologist calls for early intervention to avoid long-term cardiovascular complications

By Sandra Gray

UMass Medical School Communications

March 19, 2019
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Benjamin Nwosu, MD

A new study and a review paper from Benjamin Nwosu, MD, correlate the phenomenon known as partial clinical remission in children newly diagnosed with type 1 diabetes with cholesterol levels when they reach puberty. Published online by the Journal of the Endocrine Society, the study found that children with type 1 diabetes who did not experience partial clinical remission following initiation of insulin treatment have higher cholesterol levels in puberty than those who did. Elevated cholesterol in non-remitters is an early indication that they are at higher risk for cardiovascular complications later in life.

“A child with a history of partial clinical remission is going to have a better lipid profile during puberty, and that can extend throughout life,” said Dr. Nwosu, professor of pediatrics in the Division of Endocrinology. “This is the first study to characterize the pattern of lipid profiles in children and adolescents with type 1 diabetes as they traverse through puberty based on stratification by remission status and compared to their healthy peers.”

Partial clinical remission, also known as the honeymoon phase, occurs in children who are still secreting some insulin on their own and whose blood glucose levels can temporarily be restored to at or near normal levels with medication. Children who fail to undergo remission are more likely to experience worse cardiovascular outcomes.

“We found that puberty seems to be the primary event that separates those who go on to have good cardiovascular health from those with poorer cardiovascular history,” said Nwosu. “We believe that partial clinical remission is the pathway to a favorable cardiovascular outcome during puberty and beyond.”

Nwosu compared the lipid profiles of 71 healthy controls with 123 children with type 1 diabetes. Subjects with diabetes were stratified by remission or non-remission; healthy controls were stratified by normal weight or overweight/obese; and each subgroup was further stratified by race, sex and age. Total cholesterol, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol were significantly higher in the non-remitters compared to the remitters and normal-weight controls. Conversely, lipid profiles were similar among the non-remitters and overweight/obese controls, and among remitters and normal-weight controls.

“The findings from this study are important because they provide the much-needed data on the timing of the onset of the divergence in lipid profiles and consequent cardiovascular disease risk in youth with type 1 diabetes,” Nwosu wrote. “According to our data, this divergence occurs between ages 11 and 12 years.”

Nwosu summarizes current knowledge of partial clinical remission in type 1 diabetes in a review paper recently published in the European Medical Journal. He maintains that prompt identification of non-remitters following the diagnosis of type 1 diabetes creates an opportunity for early interventions to prevent later cardiovascular complications. He recommends three key steps: assessing the likelihood of remission or non-remission with the predictive model he developed, the adoption of a user-friendly monitoring tool for remission and non-remission, and earlier monitoring of changes in lipid profile to identify early-phase cardiovascular disease risk. For teens with unfavorable lipid profiles, early interventions include exercise, changes to diet and, if necessary, cholesterol-lowering medication.

Related stories on UMassMedNow:
New study of youth with type 1 diabetes connects ‘honeymoon period’ with lower LDL cholesterol
Benjamin Nwosu confirms accuracy of simple method to detect honeymoon period in children newly diagnosed with type 1 diabetes
Predictive tool for children with type 1 diabetes will improve care, avoid complications