This article was originally published here
Diabetes treatment. July 8, 2021: 210737. doi: 10.2337 / dc21-0737. Online before printing.
ABSTRACT
OBJECTIVE: Patients with type 1 diabetes (T1D) exhibit modest lipid abnormalities as measured by traditional metrics. This study aimed to identify lipidomic predictors of rapid decline in renal function on T1D.
RESEARCH DESIGN AND METHODS: In a case-control study, 817 patients with T1D from three large cohorts were randomly divided into training and validation subgroups. The case was defined as a decrease in the estimated glomerular filtration rate (eGFR) of> 3 ml / min / 1.73 m2 per year, while the control was defined as a decrease of <1 ml / min / 1.73 m2 per year over a follow-up period of at least 4 Years ago. Lipids were quantified in baseline serum samples using a targeted mass spectrometry lipidome platform.
RESULTS: For individual lipids, free fatty acid (FFA) 20: 2 was directly and phosphatidylcholine (PC) 16: 0/22: 6 inversely and independently associated with a rapid decrease in eGFR. When examined by lipid class, the rapid decrease in eGFR was characterized by a higher frequency of unsaturated FFAs, phosphatidylethanolamine (PE) -Ps and PCs with an unsaturated acyl chain on the sn1 carbon as well as a lower frequency of saturated FFAs, longer triacylglycerols and PCs , PEs, PE-Ps and PE-Os with an unsaturated acyl chain on the sn1 carbon at eGFR ≥90 mL / min / 1.73 m2. A multilipid panel consisting of unsaturated FFAs and saturated PE-Ps predicted a rapid drop in eGFR better than individual lipids (C statistic, 0.71) and improved the C statistic of the clinical model from 0.816 to 0.841 (P = 0.039) . The observations were confirmed in the validation subgroup.
CONCLUSIONS: In contrast to previously reported predictors of a GFR drop in type 2 diabetes, these results indicate a different incorporation of FFAs at the sn1 carbon of the glycerol backbone of the phospholipids as an independent predictor of a rapid GFR drop in T1D.
PMID: 34244329 | DOI: 10.2337 / dc21-0737
