We studied the relationship between the lipid profile, estimated GFR (eGFR) and AER in patients with type 1 diabetes. We also assessed the association between the lipid profile and glycaemic control, obesity and hypertension in an environment free of manifest renal disease, as well as exploring how well the patients would have achieved the targets set in international guidelines.

A total of 2,927 adult patients who had type 1 diabetes and for whom lipid profiles were available were included from people participating in the nationwide, multicentre Finnish Diabetic Nephropathy Study (FinnDiane). eGFR was determined using the Cockcroft–Gault formula adjusted for body surface area.

Patients with impaired renal function (eGFR <60 ml min⁻¹ 1.73 m⁻²) had higher total cholesterol, triacylglycerol and apolipoprotein B, and lower HDL-cholesterol concentrations than patients with normal renal function (eGFR >90 ml min⁻¹ 1.73 m⁻²) or mildly impaired renal function (eGFR 60–90 ml min⁻¹ 1.73 m⁻²) (p < 0.001 for all associations). In type 1 diabetic patients without manifest renal disease, similar adverse lipid profiles could be observed in those who were overweight or obese and in those who had intermediate or poor glycaemic control or hypertension. In all the different patient groups 14 to 43% would have achieved the recommended target of <2.6 mmol/l for LDL-cholesterol.

Multiple lipid abnormalities are not only present in type 1 diabetic patients with an abnormal AER, but also in those with impaired renal function. In patients without manifest renal disease, obesity, glycaemic control or hypertension were associated with an adverse lipid profile. A substantial number of patients studied would have exceeded the targets set by international guidelines, particularly the targets for LDL-cholesterol.