Type 2 diabetes mellitus influences lipid profile of ...

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CODEN (USA): ABRNBW. 88. Scholars Research Library. Type 2 diabetes mellitus influences lipid profile of diabetic patients. *. Daniel Nii Aryee Tagoe. 1,2.
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Scholars Research Library Annals of Biological Research, 2013, 4 (6):88-92 (http://scholarsresearchlibrary.com/archive.html) ISSN 0976-1233 CODEN (USA): ABRNBW

Type 2 diabetes mellitus influences lipid profile of diabetic patients *

Daniel Nii Aryee Tagoe1,2 and Philip Amo-Kodieh2

1

Department of Laboratory Technology, College of Science, University of Cape Coast, Cape Coast, Ghana 2 Medical Laboratory Section, College of Science, University of Cape Coast, Cape Coast, Ghana _____________________________________________________________________________________________ ABSTRACT Recent increases in the incidence of diabetes in developing countries have been associated with complications resulting in mortality and morbidity. This research determined the influence of type 2 diabetes mellitus (Type 2 DM) on lipid profile of diabetic patients reporting at the Dormaa Presbyterian Hospital, Ghana. A cross-sectional nonprobability sampling technique was adopted in sampling diabetics and controls visiting the hospital. One hundred and forty-three (143) confirmed Type 2 DM patients and 50 non-diabetic control patients were recruited for the study. Fasting blood samples were collected from both study and control patients and analyzed using the MICROTECH 3000 plus analyzer. Forty-three (30.1%) of diabetic patients were males whilst 100 (69.9%) were females. One hundred and thirty-three (93%) of diabetic patients were dyslipidaemic compared with 19 (38%) of control patients. Of the dyslipidaemic subjects, 111 (83.5%) were aged range 40-69. Sixty-seven (50.4%) had abnormal HDL only whilst 23 (17.3%) had abnormal TC, HDL and LDL. There was a significant association of abnormal lipid parameters in type 2 diabetic subjects (χ2=67.00, P30 kg/m2) and a sedentary lifestyle [4,7]. Dyslipidemia is elevation of plasma cholesterol, triglycerides (TGs), or both, or a low high-density lipoprotein level that contributes to the development of atherosclerosis of which causes may be primary (genetic) or secondary and diagnosed by measuring plasma levels of total cholesterol, TGs, and individual lipoproteins. It is traditionally classified by patterns of elevation in lipids and lipoproteins [8]. Dyslipidaemia is a well-recognized and modifiable risk factor that should be identified early to institute aggressive cardiovascular preventive management [9]. The most typical lipoprotein pattern in diabetes, also known as diabetic dyslipidemia or atherogenic dyslipidemia consists of moderate elevation in triglyceride levels, low HDL cholesterol values, and small dense LDL particles [10]. Type 2 DM is associated with a marked increased risk of cardiovascular disease (CVD). Thus the management of diabetic dyslipidaemia is a key approach in preventing CVD in individuals with Type 2 DM. This research aims to determine the influence of diabetes on lipid profile (dyslipidaemia) of affected subjects in Dormaa Presbyterian

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Daniel Nii Aryee Tagoe et al Annals of Biological Research, 2013, 4 (6):88-92 _____________________________________________________________________________ Hospital, Dormaa Ahenkro, Ghana a rapidly growing and urbanizing town. Findings from this research will raise awareness on the need for routine lipid profile analysis and abnormal lipid analytes and their association with CVD in clinic reviews and treatment of Type 2 DM patients. MATERIALS AND METHODS Study Area and Design The study was carried out at the Dormaa Presbyterian Hospital Diabetes Clinic, Dormaa – Ahenkro (rapidly urbanizing community) with a well-resourced hospital and a very active weekly diabetic clinic. The hospital serves both the community and several satellite areas in two very large sections in Western Brong Ahafo and Ashanti Regions. The study was conducted in the diabetic clinic and the Clinical chemistry laboratory of the hospital. A cross-sectional non-probability sampling method was adopted (Type 2 DM patients coming first at the laboratory irrespective of sex and 18years and above were recruited) after their consent had been sought. Ethical Considerations The study was approved by the Department of Laboratory Technology; University of Cape Coast and Dormaa Presbyterian Hospital Diabetes clinic, Dormaa – Ahenkro, Ghana. Informed consent was obtained from all study participants who duly acknowledge by agreeing to the study. All procedures followed were in accordance with the ethical standards Ministry of Health, Ghana as well as the Helsinki Declaration of 1975 [11]. Patients Selection Criteria The study targeted medically diagnosed Type 2 DM patients above 18 years of age and sex on diabetic treatment schedule to visit the hospital at regular intervals for routine medical review using the non-probability sampling method. Randomly selected patients 18years and above and of any sex with no history of diabetes of any type and not on Statins were used as controls. Patients Exclusion Criteria Pregnant women, patients on Statins for abnormal lipid treatment (both for Type 2 DM and Controls) were excluded. Samples and Investigations Venous blood samples were taken from both fasting diabetic and control patients into fluoride oxalate plastic for fasting Blood glucose analysis and serum separation tubes for fasting lipid profile analyses using the Microtech 3000 plus clinical chemistry analyzer (Vital Scientific BV, Netherlands). Clean wide mouthed containers were given to patients and first pass urine collected for determination of urine sugar using Bayer Multistix urine strips (Bayer Healthcare Pharmaceuticals, Germany). Dyslipidaemia (Abnormal lipid profile) was defined using the National Cholesterol Education Programme – Adult Treatment Panel III (NCEP – ATP III) (National Cholesterol Education Programme, 2002) criteria as follows; Total cholesterol > 5.3mmol/L, Low density lipoprotein > 3.30mmol/L, High Density lipoprotein < 1.0mmol/L and Triglycerideres > 1.78mmol/ L [12]. Data Analysis Data analysis was performed using SPSS 16.0 software. Descriptive analysis was done whilst Pearson’s Chi-square was used to test association between diabetes and abnormal lipid parameters. Spearman’s Rank Correlation was used to determine coefficients. (P≤0.05) is significant and (P≥0.05) not significant. RESULTS One hundred and ninety-three (193) subjects made up of 143 diabetic subjects and 50 control subjects were enrolled in the study. Of the diabetic patients 100 (69.9%) were females and 43 (30.1%) were males whilst half 25 (50%) each of control patients were males and females. Table I shows age distribution of Type 2 DM and control patients. The highest abnormal lipid analyte is High Density Lipoprotein (HDL) in both males 19(52.78%) and females 48(49.48%). The combined least abnormal analytes Triglyceride (TG) only, Low Density Lipoprotein (LDL) only and a combination of TG+LDL+Total Cholesterol (TC) 1(0.75%) (Table II). Abnormal LDL levels correlated both positively (0.717) and highly significantly (P90

Diabetics Frequency (%) 30 (21.0) 51 (35.7) 38 (26.6) 22 (15.4) 0 (0) 2 (1.3)

Control Frequency (%) 14 (28.0) 11 (22.0) 10 (20.0) 9 (18.0) 6 (12.0) 0 (0)

Table II. Frequency of Measured Abnormal Lipid Analyte in Diabetic Patients Lipid Analytes Males Females Combined Measured Parameter Frequency (%) Frequency (%) Frequency (%) TC+HDL+LDL+TG 2 (5.56) 3 (3.00) 5 (3.37) TC+HDL+LDL 4 (11.11) 19 (19.59) 23 (17.29) TG+HDL+LDL 0 (0) 2 (2.06) 2 (1.50) TC+HDL+TG 1 (2.78) 2 (2.06) 3 (2.26) TC+LDL+TG 0 (0) 1 (1.03) 1 (0.75) TC+LDL 2 (5.56) 2 (2.06) 4 (3.00) TC+HDL 3 (8.33) 2 (2.06) 5 (3.76) TG+HDL 2 (5.56) 2 (2.06) 4 (3.00) HDL+LDL 2 (5.56) 15 (15.46) 17 (12.78) HDL Only 19 (52.78) 48 (49.48) 67(50.37) LDL Only 1 (2.78) 0 (0) 1 (0.75) TG Only 0 (0) 1 (1.03) 1 (0.75) TOTAL 36 (100) 97 (100) 133 (100) TC= Total Cholesterol normal value is 5.3mmol/L; HDL= High Density Lipoprotein; LDL= Low Density Lipoprotein; TG=Triglyceride Table III. Frequency Occurrence and Correlation of Abnormal Values of Lipid Parameters in Diabetic and Control Patients Parameter Diabetics Control Correlation Abnormal Values Frequency (%) Frequency (%) Rho; P High TC 41 (17.15) 5 (18.52) 0.192; 0.007* High TG 21 (8.77) 9 (33.33) -0.040; 0.580** Low HDL 126 (52.72) 6 (22.22) 0.717; 90 (1.3%). The age of diabetic patients observed to be ≥40yrs confirmed earlier works that proves that age plays a significant role in the risk of developing Type 2 DM especially after 40yrs [13]. Majority of controls 14 (28%) were aged 40-49, the least being 80-89 6 (12.0%). Importantly however, both patients and controls were within the age ranges associated with predisposition to diabetics making for appropriate comparison of health impact of diabetics. Dyslipidaemia in Type 2 DM patients was more common (83.5%) among subjects aged between 40-69 as compared with subjects above 70 yrs (16.5%). Since all the diabetic subjects were on treatment, the difference could be attributed to the fact that subjects above 70 strictly follow their medications and undertake preventive exercises compared with those below 70yrs. Dyslipidaemia was found in 93% diabetic patients studied, much higher than the prevalence found in other studies undertaken in Tamale, Ghana 68.3%, Edo, 60.4% and Lagos 89.1% all in Nigeria and South Africa 90.3% respectively [14-16]. The high prevalence observed in this study could be attributed to urbanization in the population from the surrounding villages. Increasing urbanization has been observed to be associated with modernization of life style, which is largely characterized by physical inactivity, change in diet pattern and consequently development of obesity that is greatly considered as a risk factor for developing Type 2 DM. Twenty-Five Percent (25%) of the dyslipidaemic subjects had two lipid values outside the normal range of which the most frequent combination was low HDL and high LDL. This was similar to an earlier work undertaken by Cook et al., [17] who observed that 54% of studied subjects had two lipid values (reduced HDL and increased LDL) as the most frequent combination outside the normal range. The most frequent lipid abnormality in this study was reduced HDL which is similar to previous research works [18]. This same pattern was observed in African-American diabetics studied in USA using the American Diabetes Association (ADA) criteria [19]. Life style, environment, occupation and level of education may account for these differences [16]. Although, levels of TC and LDL in diabetic individuals are reportedly

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Daniel Nii Aryee Tagoe et al Annals of Biological Research, 2013, 4 (6):88-92 _____________________________________________________________________________ comparable with that found in non-diabetics, low levels of HDL and elevated TG have been reported in Type 2 DM patients as probable cause of CVD [20]. The study detected no sex induced significant differences (P=0.347) in lipid levels in the studied Type 2 DM patients although female subjects had higher HDL, LDL, TG and TC levels than their male counterparts. The above observation was not consistent with previous studies in African-Americans [19]. Life style, environment, occupation and level of education may account for these differences [16]. Race and sex differences in patterns of serum lipids have been noted in diabetic Africa-Americans with Type 2 DM with reportedly higher HDL and LDL levels than Caucasians whilst women diagnosed with diabetes have higher LDL and HDL concentration than their male counterparts [21]. The study showed that Type 2 DM influence abnormal lipid profile in diabetes when compared with controls in all the lipid analytes except TG that culminated in an overall significant difference using chi-square (χ2=67.00, P