Considering Cholesterol in Kids

Dyslipidemia in youth with diabetes: to treat or not to treat?, by David M. Maahs and colleagues. Journal of Pediatrics 153:458–465, 2008

What is the problem and what is known about it so far?

At least 150,000 people under the age of 20 in the United States have type 1 or type 2 diabetes. Both types of diabetes are developing at younger ages, which means that the children who get diabetes will have it for longer and may get serious complications at younger ages. Heart and blood vessel disease is the leading cause of death in people with diabetes, and the factors that lead to it are present in children. Although some progress has been made in reducing diabetes complications by tightly controlling blood glucose for more patients, some studies show that similar progress has not been made in lowering the chance of getting heart and blood vessel disease. The American Diabetes Association (ADA) and the American Heart Association (AHA) recommend treating cholesterol (blood fat) problems, which can lead to heart and blood vessel disease, in children with diabetes. However, there is a lack of information to guide such treatment.

Why did the authors write this article?

The authors wanted to review available information and guidelines about treating cholesterol problems in children with diabetes and summarize treatment and monitoring options.

What did the article say about this issue?

• Previous studies strongly suggest that making efforts to reduce heart and blood vessel disease risk factors in children can help prevent these conditions later in life.
• Recent studies have shown that cholesterol problems are widespread among children with diabetes, but few of these children take medicine to control their cholesterol. Research is lacking about the safety and effectiveness of such medicines for children.
• The ADA and AHA have guidelines for cholesterol screening and appropriate treatment for children with diabetes, including exercise, diet, and medicines when appropriate. Although these guidelines differ, both say lifestyle changes should be tried before medicines.
• There have been no studies of the effectiveness of medicines to treat cholesterol problems in children. Although these drugs seem to be safe for adults, there is the danger that their use could become widespread in children without adequate safety testing.
• Arguments against aggressively treating cholesterol problems in children with diabetes include the lack of research about the safety and effectiveness, the possibility that medicines may work differently in different people or groups of people, the costs of treatment, the possible need for life-long treatment, and some evidence that early problems can be corrected with treatment later in life.
• Arguments in favor of treating cholesterol problems in children with diabetes include the fact that the drugs have been safe in adults and some specific groups of young people, evidence that heart disease risk factors start in childhood, the high risk of heart disease in young adults with diabetes compared to those without diabetes, and concerns that cholesterol treatment in adulthood may be less effective than if treatment started at a younger age.

What are the implications of the study?

Until more research is done, health care providers will need to tailor existing guidelines to individual patients and carefully weigh the possible benefits of treating cholesterol problems in children with diabetes against the safety, cost, and other concerns.

FOR MORE INFORMATION

Diabetes, Cholesterol, and Heart Disease

Treating High Cholesterol (Blood Fats) in People With Diabetes

101 Tips for Raising Healthy Kids With Diabetes