1. Screening and Treatment of Dyslipidemia in Youth with Diabetes: Do We Follow the Guidelines?
Melissa Chambers, DO; Catherine McNeal, MD, PhD; Justin P Zachariah, MD, MPH; Laurel A Copeland, PhD; Sean Gregory, MBA, MS, PhD; Joon Song, Ph.D;
Baylor Scott & White Health, McLane Children’s Hospital, PGY-3
Screening in Youth with DM
Introduction
Youth  with type 1 (T1D) and type 2 diabetes (T2D) experience severe and early complications from diabetes including abnormalities of cardiac structure and function such as increased carotid intima-media thickness, abnormal cholesterol (total cholesterol, low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C)), and increased heart rate, thus increasing mortality and morbidity secondary to atherosclerotic cardiovascular disease (ASCVD).1,2,3 Compared to their peers affected with T1D, youth with T2D are at an even greater risk for premature ASCVD with death occurring sooner after onset of disease despite equivalent glycemic control.4  
Guidelines for lipid screening and treatment in youth with T1D and T2D recommend early lipid screening and statin therapy for those with an LDL-C >160mg/dL or >130mg/dL with other ASCVD risk factors.5 Our own data, as well as data from the National Ambulatory Medical Care Survey, show that overall lipid screening rates are well below expected rates based on past and current guidelines. Among all youth screened for dyslipidemia, few receive statin therapy. Other than data from the SEARCH for Diabetes in Youth study, nothing is known about lipid screening in youth with diabetes and no data have been reported for how dyslipidemia is treated in this high-risk population.
The aim of this study is to determine the temporal trends and guideline adherence for dyslipidemia screening and treatment in youth with T1/T2D ages 2-21 years, over the period , using the Pediatric Cardiovascular Research Network (P-CVRN) data warehouse.
Mean LDL-C in Youth with DM
Abstract
The prevalence of diabetes in youth has been steadily increasing in the last Because diabetes markedly increases the risk of developing premature ASCVD, it is imperative that the added risk factor of dyslipidemia be diagnosed and treated according to established guidelines.
A total patient population of 1,591,552 youth from 4 integrated health care organizations was assembled and evaluated including 5,582 youth with T1/T2D. Screening information, lipid levels, and lipid-lowering prescription information was tracked.
Mean HDL-C in Youth with DM
Description of study
We utilized data from a consortium of sites participating in the P-CVRN including Kaiser Permanente, Honolulu, HI, Baylor Scott & White Health, Temple, TX, Henry Ford Health System, Detroit, MI, and Geisinger Health System, Danville, PA, to evaluate temporal trends and guideline adherence with respect to screening and treatment of dyslipidemias in youth with T1D and T2D.
Queried variables included health plan membership, lab tests (e.g. lipid levels), pharmacy claims (specifically focusing on lipid-lowering prescriptions (LLRx)), utilization (clinic visits, hospitalizations), ICD-9 diagnoses, and demographics.
Data were extracted using SAS code written by our institution and deployed at different sites to extract data from each site. A subset of data was validated by chart review at our institution.
LLRX in Youth with DM
Demographics, Youth with DM
Conclusions
All youth with DM should be screened for dyslipidemia according to well-established guidelines. If abnormal, youth should be re-tested one year later. We would expect to see ~20% of youth with DM screened annually if all had normal lipids. Our study demonstrated that only ~10% of this population is screened annually, indicating that improvement in screening is needed.
Our results also show that the use of LLRx has increased over time, but is still far below expected rates based on the prevalence of dyslipidemia in the SEARCH study and our own data. The SEARCH study demonstrated LDL-C levels at or above the treatment values of 160mg/dL in 3% of youth with T1DM and in 9% of youth with T2DM, and >130mg/dL in 14% of youth with T1D and 24% of youth with T2D, all of these being youth who meet guidelines for the use of LLRx. Thus, the current treatment rate of ~1% is below expected rates of LLRx use.
These results indicate that current trends in dyslipidemia screening and treatment in youth with DM across the U.S. are increasing but are still well below the ideal levels to help prevent future ASCVD in this special population.
References
Results
Berenson, GS, et al. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Eng Journ Med Jun 4;338(23):
Urbina, EM, et al. Effect of type 1 diabetes on carotid structure and function in adolescents and young adults: the SEARCH CVD study. Diabetes Care Sep;36(9): Epub 2013 Apr 5.
Whalley GA, et al. Structural and functional cardiac abnormalities in adolescent girls with poorly controlled type 2 diabetes. Diabetes Care May;32(5): Epub 2009 Feb 5.
Constantino MI, eta l. Long-term complications and mortality in young-onset diabetes: type 2 diabetes is more hazardous and lethal than type 1 diabetes. Diabetes Care. 2013 Dec;36(12): Epub 2013 Jul 11.
American Diabetes Association. Children and adolescents. Sec. 11. In Standards of Medical Care in Diabetes – Diabetes Care 2015;38(Suppl. 1):S70-S76
Dabelea et. al. SEARCH for Diabetes in Youth Study. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to JAMA. 2014 May 7;311(17):
We would also like to acknowledge the financial support of the American Academy of Pediatrics Resident Research Grant & Scott & White Research Mentorship Award Grant
The preliminary results of the study show several interesting things:
Dyslipidemia screening in youth with diabetes is higher than screening in youth without diabetes but is still lower than expected.
Mean LDL-C levels in assessed youth with and without diabetes have declined during the study period.
Mean HDL-C levels are highest in youth with T1D, followed by youth with T2D, and lowest in youth without DM.
Rates of LLRx are higher in youth with T1/T2D compared to those without DM, but still lower than expected.
Texas Pediatric Society Electronic Poster Contest