IAJPS 2020, 07 (09), 40-44 Muhammad Asif Saleem et al ISSN 2349-7750

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INDO AMERICAN JOURNAL OF

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http://doi.org/10.5281/zenodo.4010908

Available online at: http://www.iajps.com Research Article

LIPID CHANGES IN PATIENTS WITH TYPE II DIABETES

MELLITUS AND THEIR RELATION WITH MICRO AND
MACRO VASCULAR COMPLICATIONS
1Dr Muhammad Asif Saleem, 2Dr Muhammad Umair Afzal, 3Dr Batool Riasat Ali
1
Nishtar Medical University, Multan
2
Yusra Medical College Islamabad
3
Hebei North University, China
Article Received: July 2020 Accepted: August 2020 Published: September 2020
Abstract:
Background: Patients with type II diabetes may develop complications over a longer period of time. These
complications may be related to changes in lipid markers.
Aims: To identify changes in lipid metabolism in type 2 diabetes in the context of glycemic status, its relative
impact on macro and microvascular events, and the effect of insulin therapy on lipid indexes.
Place and Duration: In the Medicine Unit-II of Jinnah Hospital Lahore for one-year duration from March 2019
to March 2020.
Methods and material: 158 patients with type II diabetes and 30 patients without coincidental illness were
selected as a control group for the study. Total cholesterol, triglycerides, HDL-C, Cholesterol / HDL-C ratio,
and atherogenic index (AI) were estimated, and the data were statistically analyzed.
Results: The atherogenic index and CHOL / HDL-C levels were significantly higher in diabetics than in the
control group. It was also found that both indices were lowered in patients treated with insulin. The AI of
patients with complications was also significantly higher than those of patients without complications; however,
CHOL / HDL-C was not significantly different. Therefore, using the best AI cut-off values can be used as a
better complication rate than the CHOL / HDL-C ratio.
Conclusion: AI may be used to indicate the presence of increased cardiovascular risk in patients with DM type
II and as a guide to an aggressive therapeutic approach.
Key words: type II diabetes mellitus, lipid indices, atherosclerotic index, micro and macrovascular
complications.
Corresponding author:
Dr Muhammad Asif Saleem, QR code
Nishtar Medical University, Multan

Please cite this article in press Muhammad Asif Saleem et al., , Lipid Changes In Patients With Type II
Diabetes Mellitus And Their Relation With Micro And Macro Vascular Complications,Indo Am. J. P. Sci,
2020; 07(09).

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INTRODUCTION: March 2019 to March 2020. After obtaining the

Diabetes mellitus, a metabolic disorder, is approval of the Institutional Ethics Committee, a
characterized by hyperglycemia and a total of 178 people aged 30 to 80 were selected for
predisposition to micro- and macrovascular this study. 148 known diabetics treated regularly as
diseases. In diabetic patients, atherosclerosis occurs cases and 30 healthy volunteers without any
at an earlier age and is the leading cause of accidental disease as controls. Patients with a
mortality in them1-2. Diabetes mellitus leads to history of smoking and alcoholism were excluded
impaired carbohydrate metabolism in combination from the study; Cases were classified according to
with impaired lipid metabolism, virtually every the level of glycemic control with HBA1c <7 as
lipid and lipoprotein is affected by Type II DM good control (group I n = 46), HBA1c 7-8
disease3-4. Elevated triglycerides associated with sufficient control (group II n = 50), and HBA1c> 8
low HDLc levels, the predominance of small dense as poor control (group III n = 52). The same 148
lipoproteins, and increased apolipoprotein B in cases were also classified into Group 1, which
diabetics are the most common patterns of included those who had complications in the last 10
dyslipidemia. Hypertriglyceridemia, a decrease in years (n = 62) and Group 2 who had never had
HDL are independent risk factors for coronary complications in the last 10 years (n = 86), to see
heart disease, small dense LDLs are also its relationship with the study parameters. The
atherogenic because they form oxidized LDL more same 148 cases were also divided into 2 groups,
often and are less well removed. Recently, it has group I were people who were on oral therapy (ie
been shown that, rather than cholesterol oral hypoglycemia) (n = 95). Group II includes
concentration in various lipoproteins, size and patients treated with insulin (n = 53). After an
composition are important in atherosclerosis5-6. TG overnight fast, peripheral venous blood samples
and TG-related ratio corresponded to glycemic were collected in two vacutainers of 5 ml in
status. In this study, we observed significantly vacutainer gel and 2 ml in EDTA vacutainer.
lower rates of TG, VLDL, and rates in diabetics Serum separated after centrifugation; was used for
taking insulin compared to other treatments. the analysis of fasting and postprandial blood sugar
However, total cholesterol and LDL-c are by GOD-POD method, total cholesterol by CHOD-
significantly higher in insulin-treated patients POD method, triglycerides by GPO-PAP method
without a significant increase in HDL-c. Insulin and HDL-c fraction determined by CHOD-POD
treatment has been shown to improve diabetes- cholesterol method. The EDTA sample was used
related dyslipidaemia. Insulin therapy increases the for the measurement of HbA1C which was
expression of the Apo A1 gene and inhibits the determined by HPLC. LDL was calculated from
production of VLDL. Various fractions of lipids the Frield walds formula, CHOL / HDL-C ratio,
and lipoproteins have been shown to be associated log AIP (TG / HDL-C) 3 was calculated in the
with diabetes complications. In this study, we different groups. The obtained data were analyzed
found significantly higher levels of total with the SPSS statistical software (version 17.0);
cholesterol, TG, VLDL and AIP, and lower HDL-c ANOVA was used to compare the 3 groups, and
in patients with complications. However, the LDL- significance was estimated using F values between
c and Chol / HDL-c ratios are not significantly the different groups.
different. To assess the importance of these
different markers, the best cut-off values were RESULTS:
calculated by ROC analysis. AIP is the only Table 1 shows the mean and SD of the various lipid
indicator that has shown significant sensitivity and fractions tested. The mean ratio of total cholesterol,
specificity in identifying diabetic complications, triglycerides, VLDL, AIP, CHOL / HDL was
and TG is another relatively better marker. All significantly higher in the patients than in the
other markers showed poor sensitivity. However, control group (p <0.001). There was no significant
since sub fractionation of lipoproteins by the increase in LDLc in patients compared to the
present method cannot be performed in all clinical control group (p = 0.478). Serum HDLc was
laboratories, AIP has recently been shown to significantly reduced in patients compared to the
correlate with lipoprotein size and composition; control group (p = 0.002). The multiple ANOVA
Therefore, in this study, we observed the lipid comparison shows that total cholesterol was
profile and the AIP and CHOL / HDL ratio in significantly higher in group III (p = 0.003) than in
patients with type II diabetes in the context of group I (= 0.422) and group II (= 0.092) compared
glycemic status and its relationship with macro and to the control group; the increase was not
microvascular events and the effect of insulin significant compared to group I with group II
therapy on lipid indices. (0.701) and group III (0.095) and group II with
group III (p = 0.784). HDL-c was significantly
MATERIALS AND METHODS: reduced in group III (p = 0.002) than in group I
This study was held in the Medicine Unit-II of (0.036) and group II (0.150) compared to the
Jinnah Hospital Lahore for one-year duration from control group; the decrease was not significant in

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comparison between group I and group II (0.981) = 0.580).

and group III (0.0740) and group II and group III (p

Table 1: Mean ± SD of Various Parameters in Cases and Controls

Controls Group I Group II Group III F value Sig

T. Chol 153.6 ± 25.16 164.7 ± 27.2 172.2 ± 22.9 178.7 ± 35.67 5.414 <.001

HDL 38.5 ± 4.39 35.6 ± 4.54 36.08 ± 3.5 34.78 ± 4.4 5.16 .002
LDL 96.4 ± 15.27 96.4 ± 20.8 96.6 ± 20.11 103.04 ± 32.6 0.83 .478
VLDL 18.6 ±0.42 32.5 ± 5.05 38.7 ± 11.24 40.93 ± 13.4 38.70 <.001
TG 93.1 ± 9.49 163.3± 25.65 194.71 ±56.8 205.3 ± 67.2 38.93 <.001

AIP 0.38 ± 0.06 0.659±0.059 0.71 ± 0.11 0.75 ± 0.1 127.14 <.001

CHOL/HDL 4.02 ± 0.85 4.59 ± 0.30 4.76 ± 0.29 5.15 ± 0.89 20.46 <.001
TG and VLDL were significantly higher in group III (p = 0.001) than in group I (= 0.001) and group II (= 0.001)
compared to the control group; and in comparison, of group I with group II (= 0.031) and group III (= 0.001)
and group II with group III (p = 0.001). LDL-c was not significantly higher in patients compared to the control
group (p = 0.7333) and between groups (p = 0.717). ANOVA for AIP shows that AIP was significantly greater
in Group III (less than 0.001), Group II (less than 0.001) compared to controls; and in Group III (less than
0.001) and Group II (less than 0.025) compared to Group I, but the increase was not significant between Groups
II and III (0.231). The CHOL / HDL-c ratio was significantly greater in Group III (less than 0.001), Group II
(less than 0.001) and Group I (less than 0.001) compared to the control group, and in Group III compared to
Group I (less than 0.001). 0.001), but the increase was not significant between groups I and II (0.700) and
groups II and III (0.086).

Table 2: Area under the curve, sensitivity and specificity, of various lipoproteins, AIP and CHOL/HDL-c
ratios; calculated from best cut off value using ROC curve.
COMPLICATION INSULIN

PARAMETER AUC SENSITIVITY SPECIFICITY AUC SENSITIVITY SPECIFICITY

T. CHOL 0.552 52% 56% 0.654 57% 67%
HDLC 0.531 27% 70% 0.597 35% 79%
LDL 0.603 41% 64 % 0.285 55 % 75 %
VLDL 0.747 40 % 99.94% 0.625 24 % 90 %
TG 0.747 64 % 78 % 0.625 25.6 % 87 %
AIP 0.810 80 % 69.7% 0.712 62.8% 75.7%
CHOL/HDL 0.564 50 % 55 % 0.628 61.4% 62.8%

ANOVA with respect to insulin therapy shows that treated with insulin than on OHA. The
total cholesterol (0.002), LDL-c (less than 0.001) complication ANOVA shows that the patients with
was significantly higher in patients treated with complications did not show an increase in total
insulin than in patients with other oral cholesterol (0.934) and LDL-c (0.652) than the
hypoglycemia (OHA), the increase in total patients without complications, but the increase in
cholesterol was significant compared to the control total cholesterol (0.019) was significantly greater
group (less than 0.001) than LDL-c (0.062). There compared to the control group, but the increase in
was no significant increase in HDL-c in insulin- LDL-c was not significant compared to the control
treated patients compared to OHA-treated patients group (0.633). Complicated patients did not show a
(0.702). Insulin therapy showed a significant significant decrease in HDL than patients without
reduction in TG (0.033), VLDL (0.031), AIP (less complications (0.652), but the decrease was
than 0.001), CHOL / HDL ratio (0.046) in patients significant compared to the control group (0.006).

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TG and VLDL showed a significant increase in controls, but TC and HDL-c did not differ
patients with complications than without significantly in different glycemic levels15.
complications (less than 0.001) and controls (less
than 0.001). The AIP was significantly greater in CONCLUSION:
patients with complications than without The present study confirms that TG and VLDL
complications (less than 0.001) and in controls abnormalities are more prominent than cholesterol
(less than 0.001). The CHOL / HDL-c ratio did not and LDL in diabetic patients, and HDL is a better
differ significantly in patients with and without marker of lipid abnormalities than total and LDL
complications. At the best cut-off value, AIP is a cholesterol. AIP is a good marker for identifying
much better marker for the identification of complications associated with diabetes and is better
complications (sensitivity 80%, specificity 70%) correlated with the glycemic status of diabetics
than the CHOL / HDL-c ratio (sensitivity 50%, treated with insulin. And because AIP can be easily
specificity 55%). calculated from routine lipid testing, AIP can be
routinely used as a marker for predicting
DISCUSSION: complications.
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