Lipides et diabète de type 1

Several lipid abnormalities, potentially atherogenic are observed in type 1 diabetes (T1D). Quantitative abnormalities of lipoproteins are observed in diabetic patients with poor glycemic control (increased plasma triglyceride and LDL-cholesterol levels) or nephropathy (increased triglycerides and LDL-cholesterol, low HDLcholesterol). Several qualitative abnormalities of lipoproteins, potentially harmful, are observed in patients with T1D, even in those with good metabolic control. These abnormalities include a cholesterol/triglyceride ratio increased within VLDLs, and decreased within LDLs and HDLs, glycation of apolipoproteins, augmented oxidation of LDLs and increase in small dense LDL particles. These qualitative changes of lipoproteins are likely to impair their metabolism and function. Thus, in patients with T1D, VLDLs and LDLs are more easily taken up by macrophages and HDLs show reduced antioxidative and vasorelaxant properties. These qualitative abnormalities are not fully explained by hyperglycemia and may partly be due to peripheral hyperinsulinemia associated with the subcutaneous route of insulin administration. The exact consequences on these qualitative lipid changes on development of cardiovascular disease, in patients with T1D diabetes, are still unknown.