European Journal of Cardiovascular Medicine

Diabetes Mellitus is fast gaining the status of a potential epidemic in India with more than 65.1 million diabetic individuals currently diagnosed with the disease.

The relationship between dyslipidemia and vascular complication of diabetes has long been of interest because both tend to occur with greater frequency in Type 2 DM. Apolipoprotein B is the principal moeity of LDL, IDL, VLDL and Lpa. Its concentration is thus a good estimate of total mass of atherogenic particles.ApoB has been associated with increased risk of microvascular disease in Type 2 Diabetes patients. Hence, present study is undertaken to study Apolipoprotein B and dyslipidemia in diabetic patients and its relation with proteinuria.

Objectives:

a.      To estimate the fasting lipid profile and ApoB levels in Type 2 Diabetes Mellitus.

b.     To correlate between ApoB levels and dyslipidemia in Type 2Diabetes Mellitus patients with proteinuria

Methods: The Study is a Hospital based cross sectional age-sex matched study conducted between November 2019 to December 2021 in hospitals attached to BMCRI.Patient’s history, vital parameters were obtained. Serum fasting lipid profile with Apolipoprotein values, renal parameters, urine ACR and blood sugars were determined. Microvascular complications of diabetes mellitus were studied and nephropathy was correlated with dyslipidemia and ApoB values. Results: In this study, 80 diabetic patients were enrolled, their serum Apolipoprotein levels and fasting lipid profile were correlated with Urine Albumin Creatinine ratio and Diabetic Retinopathy. The age distribution varied from 25 years to 78 years and majority of patients fell between 43-67 years of age. Majority of the patients were females (53.75%). The mean value of HbA1c was recorded to be 10.23±3.20. Average values of TC, TG, LDL, VLDL, HDL of the study population were 166.70±53.51mg/dl, 185.50±88.77 mg/dl, 94.72±35.78 mg/dl,  48.11±27.10 mg/dl, and 37.62±19.38 mg/dl respectively. In our study, the increasing trend of TC, TG, LDL and VLDL with increasing severity of proteinuria was observed. Further correlation test revealed a positive association of ApoB with ACR(r=0.32;p value=0.004).Correlation test between lipid profile parameters and ApoB showed a significant correlation of ApoB with all the parameters. Positive linear correlation of TG and LDL as well as negative correlation of HDL with ApoB was reported. It was found that there was a significant increase of HbA1c and ACR as the DR progressed from normal to severe proliferative form. Interpretation and Conclusion: This study demonstrates the direct association between ACR levels with lipid profile parameters TC, TG, LDL and VDL. ACR values were also found to positively correlate with ApoB and negatively correlate with HDL. Our study demonstrated a direct correlation of ApoB and dyslipidemia (increased TC and decreased HDL) with proteinuria. It was also evaluated that ACR and HbA1c levels directly impacted the fundoscopy outcome of patients with T2DM.  From our study we conclude that in type 2 diabetes patients, dyslipidemia and increased ApoB levels have an impact on predicting the likelihood of developing and progressing Diabetic nephropathy.