Effect of Metabolic Control on Lipid, Lipoprotein, and Apolipoprotein Levels in 55 Insulin-dependent Diabetic Patients: A Longitudinal Study

Plasma lipid, lipoprotein, and apolipoprotein levels were measured in 55 insulin-dependent diabetics (20 males and 35 females) before and after 2–3 wk of intensive insulin therapy in a metabolic unit. At the time of discharge from the metabolic unit the levels of total, low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL) cholesterol as well as triglycerides, VLDL triglycerides, and apolipoprotein B (Apo B) were significantly decreased. Conversely, the levels of high-density lipoprotein (HDL) cholesterol, and apolipoprotein A1 (Apo A1) were significantly increased. The data were further analyzed after subdividing the patients into two subgroups: (1) patients admitted in poor glycemic control (HbA1c > 11%) and (2) patients admitted in fair control (HbA1c < 11%). In the group admitted in poor control the changes in lipid and lipoprotein levels were similar to the ones found in the group of patients as a whole, while in patients admitted in fair control only the levels of total and VLDL triglycerides showed significant changes with control. Patients' sex appeared to influence the magnitude of changes observed in HDL cholesterol and Apo A1, levels. In males a significant increase in both HDL cholesterol and Apo A1 was achieved after glycemic control either in the whole group or in the subgroup admitted in poor control. In the subgroup admitted in fair control HDL cholesterol levels rose but no significant change was observed in the Apo A1 levels. In females no significant change was observed with improved control in HDL cholesterol and Apo A1, either in the whole group or in the group admitted in fair control. A small but significant increase was detected in the HDL cholesterol levels of the female patients admitted in poor control, but no change was observed in the Apo A1 levels. In conclusion, in insulin-dependent diabetics, normalization in plasma lipid, lipoprotein, and apolipoprotein levels was obtained after intensive insulin therapy.