Barbara Bohn1,2, Kirsten Mönkemöller3, Dörte Hilgard4, Axel Dost5, Karl Otfried Schwab6, Eggert Lilienthal7, Elke Hammer8, Kathrin Hake9, Maria Fritsch10, Bettina Gohlke11, Carine de Beaufort12,13, Reinhard W Holl1,2. 1. Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany. 2. German Centre for Diabetes Research (DZD), Munich, Germany. 3. Department of Paediatrics, Kinderkrankenhaus Amsterdamer Straße, Cologne, Germany. 4. Department of Paediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany. 5. Department of Paediatrics, University Hospital Jena, Jena, Germany. 6. Department of Paediatrics and Adolescent Medicine, University Medical Centre, Freiburg, Germany. 7. Department of Paediatrics, University of Bochum, Bochum, Germany. 8. Department of Paediatrics, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany. 9. Children's Hospital, Müritzklinikum Waren, Waren, Germany. 10. Department of Paediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria. 11. Department of Paediatric Endocrinology and Diabetology, University Hospital Bonn, Bonn, Germany. 12. Department of Paediatrics, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg. 13. Department of Paediatrics, University Hospital Brussels, UZB, Brussels, Belgium.
Abstract
OBJECTIVE: To investigate differences in cardiovascular risk factors and metabolic control in girls with type 1 diabetes with or without use of oral contraceptives (OC) from the multicenter "diabetes prospective follow-up" (DPV) registry. METHODS: Twenty-four thousand eleven adolescent girls (13 to < 18 years of age) from Germany, Austria or Luxembourg with type 1 diabetes from the DPV registry were included in this cross-sectional study. Multivariable regression models were applied to compare clinical characteristics (hemoglobin A1c [HbA1C ], blood pressure, serum lipids, body mass index) and lifestyle factors (smoking, physical inactivity, alcohol consumption) between girls with or without OC use. Confounders: age, diabetes duration and migration background. STATISTICAL ANALYSIS: SAS 9.4. RESULTS: In girls with type 1 diabetes and OC use, clinical characteristics and lifestyle factors were less favorable compared to non-users. Differences were most pronounced for the prevalence of dyslipidemia (OC-users: 40.0% vs non-users: 29.4; P < .0001) and the number of smokers (OC-users: 25.9% vs non-users: 12.5%; P < .0001). OC use, sociodemographic characteristics and lifestyle factors explained between 1 and 7% of the population variance in serum lipids and blood pressure. The use of OC explained a small additional proportion in all variables considered (<1%). CONCLUSIONS: OC use in adolescent girls with type 1 diabetes was associated with a poorer cardiovascular risk profile. Biological risk factors were partly explained by a clustering of sociodemographic and lifestyle factors with a small additional contribution of OC use. Prescription of OC should therefore be combined with a screening for cardiovascular risk factors and targeted education.
OBJECTIVE: To investigate differences in cardiovascular risk factors and metabolic control in girls with type 1 diabetes with or without use of oral contraceptives (OC) from the multicenter "diabetes prospective follow-up" (DPV) registry. METHODS: Twenty-four thousand eleven adolescent girls (13 to < 18 years of age) from Germany, Austria or Luxembourg with type 1 diabetes from the DPV registry were included in this cross-sectional study. Multivariable regression models were applied to compare clinical characteristics (hemoglobin A1c [HbA1C ], blood pressure, serum lipids, body mass index) and lifestyle factors (smoking, physical inactivity, alcohol consumption) between girls with or without OC use. Confounders: age, diabetes duration and migration background. STATISTICAL ANALYSIS: SAS 9.4. RESULTS: In girls with type 1 diabetes and OC use, clinical characteristics and lifestyle factors were less favorable compared to non-users. Differences were most pronounced for the prevalence of dyslipidemia (OC-users: 40.0% vs non-users: 29.4; P < .0001) and the number of smokers (OC-users: 25.9% vs non-users: 12.5%; P < .0001). OC use, sociodemographic characteristics and lifestyle factors explained between 1 and 7% of the population variance in serum lipids and blood pressure. The use of OC explained a small additional proportion in all variables considered (<1%). CONCLUSIONS: OC use in adolescent girls with type 1 diabetes was associated with a poorer cardiovascular risk profile. Biological risk factors were partly explained by a clustering of sociodemographic and lifestyle factors with a small additional contribution of OC use. Prescription of OC should therefore be combined with a screening for cardiovascular risk factors and targeted education.