European Journal of Cardiovascular Medicine

Diabetes mellitus is an important risk factor for cardiovascular disease and atherosclerosis as it is a common secondary cause of hyperlipidemia when the glycemic control is poor.¹ Furthermore, poorly controlled diabetes can indirectly contribute to abnormal blood fat (lipid) levels, a condition called hyperlipidemia. In this scenario, diabetes may lead to an increase in "bad" LDL cholesterol and triglycerides, while decreasing "good" HDL cholesterol. This unhealthy lipid profile further accelerates atherosclerosis.³

The combination of damaged blood vessels and unhealthy cholesterol levels significantly increases the risk of various cardiovascular complications. These complications can include coronary artery disease (heart attack), stroke, peripheral arterial disease (circulation problems in legs), and heart failure. In essence, uncontrolled diabetes creates a double threat to the cardiovascular system, making it a critical health concern. ^4,5

Asian Indians appear to have a higher risk of CAD compared to white populations, highlighting a potential genetic or environmental component that warrants further investigation. This confluence of factors underscores the critical need for effective management strategies to address both diabetes and its associated cardiovascular risks.^9,10 Present study was aimed to investigate the association between dyslipidemia, duration of type 2 diabetes mellitus, and HbA1c in patients with T2DM at a tertiary care center.

Present study was cross- sectional descriptive study, conducted in department of General Medicine, at Vilasrao Deshmukh Government Medical College And Hospital Latur, India. Study period was of 18 months (AUGUST 2022 to Feb 2024). Study was approved by institutional ethical committee.

Inclusion criteria

• All type 2 diabetes mellitus patients of age ≥ 18 years, either gender, willing to participate in the study and has given written

Exclusion criteria

• Patients who are severely ill, who were critically ill in last 3
• Patients with liver diseases, chronic kidney disease, hypothyroidism, hypertension, type 1 diabetes mellitus
• Patients on drugs that alter lipid profile (ex. Steroids, antithyroid drugs, OCP) and smoking habits.
• Patients suffering from other causes of secondary dyslipidaemia OR with coexisting disease associated with
• Pregnant
• Patients who will not give written

Study was explained to participants in local language & written informed consent was taken. Baseline demographic variables were collected: age, weight, height, BMI, education, occupation, religion, income, address, type of family, socioeconomic status, and co-morbidities. We collected patients' data, including their gender, age, nationality, and blood analysis (lipids profile - TGs, HDL, LDL, and hemoglobin A1c (HbA1c) levels). All available previous reports including fasting, postprandial sugar level, and hemoglobin level were also collected. Blood pressure was measured by using a sphygmomanometer.

The data was coded and entered into Microsoft Excel Worksheet & analysed using SPSS 23.0 version. Frequency, percentage, means and standard deviations (SD) was calculated for the continuous variables, while ratios and proportions were calculated for the categorical variables. Difference of proportions between qualitative variables were tested using chi- square test or Fisher exact test as applicable. P value less than 0.5 was considered as statistically significant.

Among 233 participants, majority of fall within the 41-50 years age group (43 %), followed by 51-60 years (25 %) & 31-40 years (17%). Out of the total 233 participants, 64 are male, which constitutes 27.5% of the sample. The remaining 169 participants are female, making up a significant majority at 72.5%.

Table 1: General characteristics

Out of 233 participants, 23 (10%) have a BMI less than 18.5, indicating they are underweight, with the lowest lipid values: TC (12), TG (11), LDL (11), and HDL (12). A total of 93 participants (40%) fall into the normal BMI range (18.5-24.9), showing intermediate lipid levels: TC (63), TG (49), LDL (47), and HDL (60). The largest group consists of 117 participants (50%) with a BMI over 25, indicating they are overweight or obese, and they exhibit the highest lipid levels: TC (100), TG (100), LDL (116), and HDL (100). The overall lipid values for all participants are 175 for TC, 160 for TG, 174 for LDL, and 172 for HDL, demonstrating a clear association between increasing BMI and elevated lipid levels.

Table 2: Distribution of the study participants according to the BMI.

Among the 233 participants, 14 (6%) have had diabetes for less than one year, and only 1 of them exhibit dyslipidemia. A total of 46 participants (20%) have had diabetes for 1-5 years, with 15 cases of dyslipidemia. The majority, 128 participants (55%), have had diabetes for 5-10 years, and a significant 119 of them show dyslipidemia. Lastly, 45 participants (19%) have been living with diabetes for more than 10 years, 40 of whom have dyslipidemia. Overall, 175 participants in the study present with dyslipidemia, highlighting a strong association between the duration of diabetes and the likelihood of developing dyslipidemia.

Table 3: Distribution according to the duration of the diabetes mellites.

Out of the 233 participants, 175 have dyslipidemia, which constitutes 75% of the sample. 175 have cholesterol levels exceeding 200 mg/dL, accounting for 75% of the sample. 160 have triglycerides levels above 150 mg/dL, accounting for 68.5% of the sample. 210 have LDL cholesterol levels exceeding 130 mg/dL, making up 75% of the sample. 19% had normal HDL levels (>40 mg/dL), while 8% had abnormal levels (<40 mg/dL). In females, 7% had normal HDL levels (>50 mg/dL), while a significant 66% had abnormal levels (<50 mg/dL)..

Table 4: distribution of study participants based on the presence of dyslipidemia.

Among the 233 participants, 57 patients (24%) have HbA1c levels between 6.5 and 7.5, with 7 cases of dyslipidemia. A total of 33 patients (14%) falls in the 7.6 to 8.5 range, and all 33 of them present with dyslipidemia. The majority of participants, 93 (40%), have HbA1c levels between 8.6 and 9.5, with 85 cases of dyslipidemia. Lastly, 50 patients (21%) have HbA1c levels above 9.6, all of whom exhibit dyslipidemia. Overall, 175 patients in the study suffer from dyslipidemia, indicating a strong correlation between higher HbA1c levels and the prevalence of dyslipidemia.

TABLE 5: Distribution Of The Patients According To The Hba1c Level.

FBS shows minimal variation across the groups: 180 ± 60 in the <7.5 group, 180.36 ± 38.45 in the 7.5-9.5 group, and 179.45 ± 11.75 in the >9.5 group, with no statistically significant difference (p = 0.111). Total cholesterol increases with rising HbA1c levels, from 194.91 ± 23.97 in the <7.5 group to 218.21 ± 28.75 in the >9.5 group, showing a significant correlation (p = 0.0021). Triglycerides also show an upward trend, rising from 139.28 ± 24.68 in the <7.5 group to 172.50 ± 12.25 in the >9.5 group, with a statistically significant difference (p = 0.0211). LDL levels increase from 142.29 ± 20.97 in the <7.5 group to 155.01 ± 15.57 in the >9.5 group, and this correlation is significant (p = 0.0351). HDL levels show little variation across the groups, with values of 40.87 ± 6.47, 42.0 ± 9.5, and 41.70 ± 10.50, and no significant correlation (p = 0.765).

Overall, total cholesterol, triglycerides, and LDL levels increase as HbA1c levels rise, suggesting a strong correlation between poor glycemic control and lipid abnormalities, while FBS and HDL do not show significant changes with HbA1c levels.

Table 6: Correlation of biochemical parameters with glycosylated hemoglobin.

Of the study participants, 19.74% had diabetic retinopathy, a common eye complication, and another 19.74% had albuminuria, indicating kidney damage.

Table 7: Complications

Triglycerides and LDL cholesterol levels are significantly associated with the duration of diabetes, highlighting the progressive impact of the disease on lipid metabolism.

Table 8: Correlation of biochemical parameters with duration of diabetes mellitus.

There is significant difference in cholesterol, triglycerides, LDL, HDL, HBA1C levels in those have diabetes greater than 5 years and less than 5 years. there is no significant difference in FBS level in those have diabetes greater than 5 year and less than 5 years.

Table 9: T test: correlation of duration of diabetes mellitus and dyslipidemia

The T Test shows significant difference in cholesterol, triglycerides, LDL levels in those have HBA1C greater than 7.5 and less than 7.5. there is no significant difference in FBS and HDL level in those have HBA1C greater than 7.5 and less than 7.5.

Table 10: T Test: correlation of HBA1c and dyslipidemia

The statistical analysis shows no significant difference in FBS level in patients of dyslipidemia. there is significant difference in HBA1C level in patients of dyslipidemia.

Table 11: T Test: Correlation of FBS and HBA1C with dyslipidemia

Dyslipidemia in diabetes mellitus refers to raised low-density lipoprotein cholesterol (LDL-C), decreased high-density lipoprotein cholesterol (HDL-C) levels, or elevated triglyceride (TG) levels.⁷ The frequency of diabetes mellitus is increasing many folds in South Asian population due to the high degree of genetic predisposition and high susceptibility to environmental insulin, characterized by a high BMI, high upper body adiposity, a high body fat percentage and a high level of insulin resistance.⁸

Term “dyslipidemia" is increasingly popular to describe abnormal changes in lipid profile, replacing the old term hyperlipidemia". Dyslipidemia encompasses changes in High density lipoprotein cholesterol (HDL-C), the size and density of Low-density lipoprotein cholesterol (LDLC), very low-density dyslipidemia comprises triad of raised triglycerides, reduced HDLC and excess of small, dense LDL particles.⁹

Kidwai SS et al.,¹⁰ studied 142 participants, with a mean age of 54.95 ± 10.6 years. The gender distribution in the present study showed a significant predominance of female participants, comprising 72.5% (169 out of 233), compared to 27.5% males (64 out of 233). This gender ratio aligns with the previous study, which also had a higher proportion of females (103 out of 142) compared to males (39 out of 142).

Overall, both studies indicate a female-dominated participant pool with similar mean ages around the mid-50s. The present study, however, had a larger and more detailed age distribution, highlighting a concentration of participants in the 31-40 years age group, which was not explicitly noted in the previous study.⁷ The similarities in gender distribution and mean age suggest consistent demographic characteristics across the studies, despite the larger sample size in the present study.

Of the 233 participants, 6% had diabetes for less than 1 year, while 20% had it for 1-5 years. The largest group, comprising 55%, had diabetes for 5-10 years, and 19% had been living with the condition for more than 10 years. Comparatively, the previous study (Kidwai SS et al.,⁷) showed that 14% of participants had diabetes for less than 12 months, 28% had diabetes for 1-5 years, and 58% had diabetes for more than 5 years. This indicates a higher proportion of long-term diabetes cases in the previous study compared to the present study.

In study by Shahwan MJ et al.,¹¹ mean TGs were 165.92 mg/dl with males having a mean of 149.73 mg/dl and females 171.81 mg/dl. The mean LDL cholesterol level was 106.10 mg/dl, with males at 99.66 mg/dl and females at 108.44 mg/dl. The HDL cholesterol levels had a mean of 39.52 mg/dl, with males at 42.80 mg/dl and females at 38.33 mg/dl. Additionally, the demographics and lipid profiles categorized by HbA1c levels showed that participants with HbA1c levels above 7% had higher mean TGs (175.39 mg/dl) and LDL (107.59 mg/dl) compared to those with HbA1c levels up to 7% (138.56 mg/dl for TGs and 97.85 mg/dl for LDL).

When comparing both studies, it is evident that dyslipidemia is prevalent among the participants, as shown by the high percentages of elevated cholesterol, triglycerides, and LDL levels in the present study. The previous study⁸ provides mean values that suggest a general trend towards elevated lipid levels, especially among females. The present study's categorical data complements the previous study⁸ by providing a clear picture of the high prevalence of dyslipidemia and elevated lipid levels.

The present study analyzed the correlation between dyslipidemia and factors such as the duration of diabetes mellitus, HbA1c levels, and fasting blood sugar (FBS) using T-tests. The correlation between cholesterol levels and diabetes duration showed a statistically significant result, with a T-test statistic of 6.1043 and a p-value of 5.04×10⁻⁹, leading to the rejection of the null hypothesis (H0). Similarly, significant correlations were observed for triglycerides (T = 8.7721, p = 5.85×10⁻¹⁵), LDL (T = 4.938, p = 2.81×10⁻⁶), and HbA1c (T = 7.7587, p = 1.57×10⁻¹²), all of which resulted in the rejection of H0. However, the correlation of FBS and HDL with dyslipidemia was not significant, with p-values of 0.5998 and 0.5380, respectively, leading to the acceptance of H0. Additionally, the correlation of FBS and HbA1c with dyslipidemia demonstrated that HbA1c had a significant effect (T = 15.0590, p = 2.2×10⁻¹⁶), while FBS did not (T = -0.0610, p = 0.9515).

Rafael Fagundes Melo et al.,⁹ studied the association of HbA1c levels with dyslipidemia in diabetic patients. The study divided patients into three groups based on HbA1c levels: <7%, 7-7.9%, and ≥8%. In the group with HbA1c ≥8%, 45.7% had cholesterol >170 mg/dL, and 30.4% had triglycerides above threshold levels (75-90 mg/dL). LDL levels >110 mg/dL were observed in 10.9% of the same group, while 15.2% had HDL levels <45 mg/dL. Dyslipidemia prevalence was highest in the group with HbA1c between 7-7.9%, at 73.3%, and lowest in the group with HbA1c <7%, at 60%.

Both studies explored the relationship between HbA1c levels and dyslipidemia in diabetic patients, finding a clear association between higher HbA1c levels and dyslipidemia. The present study identified statistically significant correlations between HbA1c, cholesterol, triglycerides, and LDL with dyslipidemia, similar to the findings of Rafael Fagundes Melo et al. (2024), where higher HbA1c levels corresponded to increased cholesterol and dyslipidemia prevalence. However, the present study also analyzed FBS, which did not show a significant correlation with dyslipidemia, whereas Rafael Fagundes Melo et al.,⁹ focused more on cholesterol, triglycerides, and non-HDL- c levels. Both studies reinforce the importance of managing HbA1c in diabetic patients to reduce dyslipidemia risk, though the present study offers a more comprehensive analysis of specific lipid parameters over time.

The study reveals a predominance of middle-aged individuals, particularly those aged 41-50 years, among the participants. The majority of participants have a long-standing history of diabetes, with a significant portion having had the condition for 5-10 years. This extended duration underscores the chronic nature of diabetes among the study population. The high prevalence of dyslipidemia among 75% of participants suggests a critical need for regular monitoring and management of lipid levels.  

The distribution of HbA1c levels reveals a significant portion of participants with poorly controlled diabetes. The correlation analysis indicates that higher HbA1c levels are associated with elevated total cholesterol, triglycerides, and LDL, emphasizing the relationship between poor glycemic control and adverse biochemical profiles.

Conflict of Interest: None to declare

Source of funding: Nil

1. Kolhar U, Priyanka P. Study of serum lipid profile in type 2 diabetes mellitus patients and its association with diabetic nephropathy. Int J Adv Med. 2017;4(6):1513-6.
2. Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: cardiovascular disease in diabetes mellitus: atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus–mechanisms, management, and clinical considerations. Circulation. 2016 Jun 14;133(24):2459-502.
3. Feingold KR. Role of Glucose and Lipids in the Atherosclerotic Cardiovascular Disease in Patients with Diabetes.
4. Matheus AS, Tannus LR, Cobas RA, Palma CC, Negrato CA, Gomes MD. Impact of diabetes on cardiovascular disease: an update. International journal of hypertension. 2013 Oct;2013.
5. Krauss RM, Siri PW. Dyslipidaemia in type 2 diabetes. Medical Clinics. 2004 Jul 1;88(4):897-909.
6. Hyassat D, Al-Saeksaek S, Naji D, Mahasneh A, Khader Y, Abujbara M, El-Khateeb M, Ajlouni K. Dyslipidaemia among patients with type 2 diabetes in Jordan: Prevalence, pattern, and associated factors. Frontiers in Public Health. 2022 Nov 8; 10:1002466.
7. Kidwai SS, Nageen A, Bashir F, Ara J. HbA1c–A predictor of dyslipidemia in type 2 Diabetes Mellitus. Pakistan Journal of Medical Sciences. 2020 Sep;36(6):1339.
8. O'brien T, Nguyen TT, Zimmerman BR. Hyperlipidemia and diabetes mellitus. Mayo Clinic Proceed. 1998;73(10);969-76.
9. Uttra KM, Devrajani BR, Shah SZA, Devrajani T, Das T, Raza S, Naseem: Lipid profile of patients with diabetes mellitus (A Multidisciplinary Study). World Appl Sci J 2011, 12(9):1382-1384.
10. Mooradian AD: Dyslipidemia in type 2 diabetes mellitus. Nat Clin Pract Endocrin Metab 2009, 5:150-159.
11. Shahwan MJ, Jairoun AA, Farajallah A, Shanabli S. Prevalence of dyslipidemia and factors affecting lipid profile in patients with type 2 diabetes. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2019 Jul 1;13(4):2387-92.
12. Fagundes Melo R, Laurindo LF, Sloan KP, Sloan LA, Cressoni Araújo A, Bitelli P, Laís Menegucci Zutin T, Haber Mellen R, Junqueira Mellen L, Landgraf Guiguer E, Cera Albarossi JP. Investigating the Incidence of Dyslipidemia among Brazilian Children and Adolescents Diagnosed with Type 1 Diabetes Mellitus: A Cross- Sectional Study. Diseases. 2024 Feb 24;12(3):45.`