Types of Dyslipidemia in Type 2 DM Patients of Bhubaneswar region

BACKGROUND: A characteristic pattern, termed dyslipidemia, consists of deranged of any single components of lipid profile test. This pattern is most frequently seen in diabetes and may be a preventable risk factor for subsequent cardiovascular disease. This study determined the influence of type 2 diabetes mellitus (T2DM) on lipid profile of diabetic patients reporting in a tertiary hospital in Bhubaneswar, India.


Introduction
Diabetes mellitus (DM) is a syndrome consisting of metabolic, vascular and neuropathic components that are interrelated.It is defined as group of metabolic disorder that is characterized by hyper-glycemia resulting from defect in insulin secret-ion, insulin action or both.The lack of effective insulin action leads to alteration in carbohydrate, fat and protein metabolism [1].T2DM is caused by relatively impaired insulin secretion and peripheral insulin resistance [2].
Diabetes is no more an epidemic but it has it has been turned into a global pandemic.Diabetes has been recognized as a health threat worldwide.As per the global projection by international diabetes foundation the number of diabetic patients has risen sharply in recent years.While in 1985, thirty million people had diabetes worldwide; the number rose to one hundred million in 2000, two hundred eighty five million in 2010 and is estimated to be four hundred thirty five million, 7.8% of the adult world population, by 2030 [3].
According to WHO, 70% of current cases of diabetes, occur in developing countries [4].Among these India has the world's largest population with an estimated 50.8 million people living with diabetes [3].The international journal of diabetes for developing countries has declared India as the diabetes capital of the world [5].
A characteristic pattern, termed dyslipidemia, consists of increased triglycerides (TAG), Total cholesterol (TC), low density lipoprotein (LDL), and very low density lipoprotein (VLDL) cholesterol and decreased high density lipoprotein (HDL).This pattern is most frequently seen in diabetes and may be a preventable risk factor for subsequent cardiovascular disease.
Patients with T2DM are at greater risk of developing vascular diseases because of lipid changes.Lipid abnormalities and insulin use is critically discussed in diabetics [6].The most typical lipoprotein pattern reported in diabetes, also known as diabetic dyslipidemia or atherogenic dyslipidemia consists of moderate elevation in TC, TAG and LDL-Cholesterol levels with or without low HDL-Cholesterol levels in blood.
The degree of variations in lipid profile of diabetic patients may not generalized to all region and should be individualized to specific regions as ethnic, hereditary and environmental factors influence lipid profile.Due to increasing cardiovascular problems in T2DM patients [7], this study was conducted to observe the co-relation of T2DM and types of lipid abnormalities in T2DM.Thus this research aims to evaluate the types of dyslipidemia in T2DM patients of Bhubaneswar region.

Methods
The study was carried out on the patients of medical OPD at Hi-Tech Medical College and Hospital in Bhubaneswar.50 T2DM patients were recruited after their consent had been sought.
The study targeted T2DM patients, medically diagnosed by American Diabetes Association (ADA) criteria.Randomly selected age and sex matched individuals, with no history of diabetes or any type of illness and not on statins were used as controls.
Patients with type 1 DM, other ailments, metabolic disorders and other causes of hyperlipidemia were not included in this study.Pregnant women, patients on statins for abnormal lipid treatment (both for T2DM and controls) were also excluded.
Venous blood samples were taken from both diabetic and control patients at overnight fasting and 2 hours post prandial state.Investigations carried out were, blood glucose fasting and 2 hrs post prandial blood glucose, and fasting lipid profile including TC, TAG, HDL-C, LDL-C and very low density lipoprotein cholesterol (VLDL-C).
Serum TC was determined by an enzymatic (CHOD/PAP) colorimetric method and TAG was determined by an enzymatic (GPO-PAP) method [8].HDL-C was estimated by a precipitant method and LDL-C by was estimated by using Friedewald's formula as shown below: LDL-C = TC -HDL-C -(TAG/5), where TAG/5 is approximately equal to VLDL-C.
Serum glucose was determined by using the glucose oxidase/per oxidase enzymatic method [2].Dyslipidemia was defined using the National Cholesterol Education Programme -Adult Treatment Panel III (NCEP -ATP III) (National Cholesterol Education Programme, 2002) criteria as shown in Table 1.Another study done by Rakesh et al [9] most common pattern was combined dyslipidemia with high LDL and low HDL in both males (22.7%) and females (33%).
In a study by H. Surekha Rani et al [16] an attempt has been made to evaluate the risk factors for coronary heart disease in DM patients.It is observed that, TC, VLDL, LDLs, TGs were high and the levels of HDLs were low compared to controls.
A significant difference was noticed in the VLDL Cholesterol level in control and cases where mean ±S.D is 23.84±4.70 and 38.90±15.73 of control and cases respectively with p value <0.001.

Conclusion
T2DM patients in this study had elevated levels of TAG, TC with slightly elevated levels of LDL-C and reduced levels of HDL-C.This indicates the influence of T2DM on abnormal lipid profile of patients with its associated danger of elevated CVD risk.
Diabetic patients with complication tend to have higher levels of lipid fractions (TAG, T. Chol, LDL and VLDL) and lower level of HDL.This suggests that there appears to be some relation between the geneses of various vascular complications in the presence of lipid abnormality.So it is important to aim at critical control of diabetes mellitus to prevent or at least postpone the onset of various hyperlipidemia related complications.

Table 2 .
Fasting and post prandial serum glucose of type 2 diabetic patients and controls