Weight gain accompanying intensive diabetes therapy in type I diabetes is associated with higher levels of dense LDL cholesterol

Coronary artery disease (CAD) is the major cause of mortality In type I dabetes mellitus (IDDM). We reported reductions in Lp(a), apolipoprotein B (apoB), and dense LDL with intensive dabetes therapy (I NT) in the Diabetes Control and Complications Trial (DCCT). Weight gain is a known sequela of INT. Therefore, we investigated the relationship between weight gain and lipids in INT subjects (n = 582 out of 619 elegible who were age 118 at beginning) from the DCCT at baseline and follow-up; and measured apoB, Lp(a), and dense LDL at follow-up (mean 6.2 years). Results were compared using a t-test of means between those whose weight gain was in the lowest quartile (n=146) and those whose weight gain was in the highest quartile (n=145), as measured by change hi BMI from baseline (ΔBMI). Baseline variables were not Different between the groups (data not shown) except that those with the highest ΔBMI had a higher hemoglobin A_1c (HbA_1c) than those with the least ΔBMI (9.3% vs. 8.6%, p < 0.001). At follow-up, those receiving INT with the highest ΔBMI had significantly more cholesterol in the dense LDL fractions; higher levels of triglycerides (TG), total cholesterol (TC), LDL, and apoB; tower HDL cholesterol; and required greater amounts of Insulin to achieve the same glycemic control as the group with the least ΔBMI. Lp(a) levels and 24 hour albumin excretion rates (AER) wt;e not significantly different between Ine groups. Compared with those who had the least ΔBMI, subjects with the greatest weight gain snowed deterioration in all lipids (except Lp(a)) including increased cholesterol earned in dense LDL. The potential contribution of these lipid changes associated with the greatest weight gain from INT to CAD risk in this population will be an important part of the DCCT follow-up study.