https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/50 Tue, 02 Aug 2016 10:53:07 +0000 Diabetes mellitus is recognized as a serious global health problem and frequently associated with disabling and lifethreatening complications related to some modifiable risk factors. One of the modifiable factors is dyslipidemia. This study addressed the dyslipidemic status of 124 subjects with type 2 diabetes mellitus (T2DM) attending the outpatient department, Ibrahim General Hospital and Diabetic Care and Education Center Dhanmondi, Dhaka during the period from January to June 2010. The diagnosed diabetic subjects were interviewed and the biochemical investigation data were collected from record review. Three fourth of the respondents were female and majority (24.2%) of them were 46 to 50 years of age. Most of the respondents were graduates having neuclear families. The mean total cholesterol and triglyceride were found 181.7±43.0 mg/dl and 161.0±112.5 mg/dl respectively. According to NCEP ATP III (2001), 59.7% of the participants had high level of low density lipoproteins (LDL) and only 18% had desired level of high density lipoproteins (HDL). The mean (±SD) of LDL and HDL were 109.8±37.0 mg/dl and 41.0±7.9 mg/dl respectively. Men had elevated level of mean TG with wide variation (185.98±179.56 mg/dl) than women (151.63±72.16 mg/dl). The mean (±SD) of HDL was found lower in men than women (35.8 ± 6.3 vs. 42.9 ± 7.5 mg/dl, p< 0.05) though not significant. The study revealed that dyslipidemia (high TC, TG, LDL and low HDL) was prevalent among the T2DM subjects, which needs attention of equal importance to maintain within normal limit as with the control of hyperglycemia and hypertension. Address for Correspondence:Dr. Nazia Elham, Lecturer, Department of Community Medicine, Ibrahim Medical College, 122 Kazi Nazrul Islam Avenue, Shahbagh, Dhaka, E-mail: naziaelham@yahoo.com   Diabetes mellitus (DM) is considered as a compound of complex metabolic syndrome and can lead to both micro and macrovascular complications.1 The long–term effects of diabetes mellitus include progressive development of the specific complications of retinopathy, nephropathy, and or neuropathy with risk of foot ulcers, amputation, and features of autonomic dysfunction. People with diabetes are also at increased risk of cardiovascular, peripheral vascular and cerebrovascular disease.4 Diabetic subjects have significantly higher cholesterol, triglycerides, LDL and significantly lower HDL cholesterol as compared to non diabetic subjects.8 The plasma triglyceride levels are the metabolic markers most closely related to poor glycemic control and high levels of VLDL and LDL and with a low level of HDL are associated with poor glycemic control also.2 High proportion of upper-body fat or abdominal fat, independent of overall obesity, is recognized as an important component in the insulin resistance linked to obesity and type 2 diabetes mellitus. 9   This cross sectional study was carried out on 124 already diagnosed adult type 2 diabetic patients attending the outpatient department of Ibrahim General Hospital and Diabetic care and education Center, Dhanmondi, Dhaka during the period from January to June 2010. Patients of both sexes aged 20-60 years and having lipid profile done within 3 months of the interview were purposively selected in the study. Desired and abnormal category of lipid profiles of the respondents was done by following cut off values according to the National Cholesterol Education Program guideline. The study was approved by the Ethical Committee of the National Institute of Preventive and Social Medicine.   Socio-demographic characteristics of the respondents   Lipid profile data included total cholesterol (TC), triglyceride, LDL and HDL. About one-third of the diabetics were with high TG and less than one-third (27%) and more than half (59.7%) were with high total cholesterol (TC) and high LDL respectively. HDL was abnormal in more than 80% patients. ANOVA was done to see the difference in lipid profile between different age groups but found insignificant. The Pearson’s correlation coefficient between age and lipid profile also didn’t show any significant relation. ANOVA was done to see the difference of lipid profile in different occupation. Mean TC and TG was highest among the businessmen. Housewives had highest mean HDL (42.82±7.59 mg/dl). The differences in TC, TG and LDL was not statistically significant but the difference in HDL was statistically significant between housewives and respondents of other occupation (F=5.87, p < 0.05). According to standard cut-off value the lipid profile data were categorized into normal and abnormal and the influence of socio-demographic status was tested. Respondents in the middle age group had more commonly high TC, TG and LDL level than other groups. Aged persons (>55 years) had lowest percentage of high cholesterol (13.6%) and high TG (22.7%). LDL were high in 41.7% of the youngest age group of <36 years and 45.5% of the oldest age group. Desired HDL level was observed in 33.3% of respondents of <36 years age. Other age groups included a few with desired HDL level. Chi-square test did not show any influence of age on lipid profile. Businessmen had highest percentage of high cholesterol (40%) and TG (45%) than the other groups. Service holders had highest percentage (57%) and housewives had lowest percentage (5%) of high LDL. Desired HDL level was observed highest in housewives (30.0%). Occupation had no significant influence on lipid profile. [Table 2]     Table 2: Sociodemographic characteristics and percentage of dyslipidemia   This was a cross sectional study carried out among 124 diagnosed adult type 2 diabetic patients. Patients having diabetic complications were excluded from the study. Patients having severe physical and mental illness were also excluded from the study. Most of the respondents resided in the urban area (95.2%). This was due to purposive selection of study place, which was a diabetic hospital located in the center of the capital city Dhaka. So urban people naturally had more chance for being included in the study. Majority of the respondents were housewives (58.1%) as female subjects constituted three-fourth of the samples. Among the males the second highest group was service holders (25.8%) and 16.1% were business men. In this study TC, TG, LDL and HDL data were collected from record and reviewed. A study done by Arora et al. shows that abnormal lipid profile is common in diabetic patients and is an important predictor for metabolic disturbence.13 Therefore one of the important target for diabetes management is to keep lipid profile within normal limit. This study revealed that most of the respondents had total cholesterol and triglyceride within normal limit but majority had abnormal LDL (about 60%) and HDL (82%) level. Businessmen had highest mean cholesterol (40%) and TG (45%) among all occupation groups. Housewives had highest mean HDL (42.94±7.59mg/dl). T. cholesterol, TG and LDL was not statistically significant but the difference of HDL was statistically significant between housewives and respondents of other occupation (F= 5.87, p < 0.05). This cannot be explained why the housewives had significantly higher level of HDL than other occupational groups. It may be due to less psychosocial stress or dietary habit or household physical activities or may have combined influence. The study had several limitations. Had this study included anthropometry and dietary intake it could have some chances to explain further. Probably due to small sample size associations of lipid fractions with age, sex, education, occupation and family-income could not be estimated. The study did not include the duration of diabetes which could also have influence on the interaction of the said socio-demographic characteristics. The other important limitation is that there were no reference values of lipid fractions for Bangladeshi population for valid comparison. Conclusion   1.   World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its complications: Report of a WHO Consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus. Geneva: World Health Organization; 1999. 3.   Rahim MA, HussainA, Khan AK et al. Rising prevalence of type 2 diabatas in rural Bangladesh: a population based study. Diabetes research and clinical practice 2007; 77: 300-5. 5.   Shammari F, Al-Meraghi O, Nasif A,Al- Otaibi S. The Prevalence of Diabetic Retinopathy and associated Risk Factors in Type 2 Diabetes Mellitus in Al-Naeem area (Kuwait). Middle East Journal of Medicine 2005; 3(2): 7.   Ravid M, Brosh D, Safran D, Levy Z et al. Main Risk Factors for Nephropathy in Type 2 Diabetes Mellitus Are Plasma Cholesterol Levels, Mean Blood Pressure, and Hyperglycemia. Archives of Internal Med 1998; 158: 998-1004. 9.   Fox C, Coady S, Sorlie P et al. Increasing Cardiovascular Disease Burden Due to Diabetes Mellitus. Circulation 2007; 115: 1544-1550. 11.Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and treatment of High Blood Cholesterol in Adults. final report. National Institute of Health 2002. NIH Publication No. 02-5215. 13  Arora M, Koley S, Gupta S et al. A Study on Lipid Profile and Body Fat in Patients with Diabetes Mellitus. Journal of Anthropologist 2007; 9(4): 295-298. 15.France M, Kwok  S, McElduff  P. Seneviratne C. Ethnic trends in lipid tests in general practice. Oxford Journals 2003; 96(12): 919-923. 2026 Ibrahim Medical College. All rights reserved.