Original Article Journal of Nepal Association for Medical Laboratory Sciences P.

11-13

Pattern of Dyslipidemia in Type  Diabetic

Subjects in Eastern Nepal
Prashant Regmi1*, Prajwal Gyawali1, Rojeet Shrestha2,
Manoj Sigdel2, Kisun D Mehta1, Shankar Majhi1
1
Dept. of Biochemistry, BP Koirala Institute of Health Sciences, Dharan.
2
Dept. of Biochemistry, IOM, TUTH, Kathmandu.

ABSTRACT
Introduction: Cardiovascular disease (CVD) is the leading cause of death and disability in both developed
as well as developing countries. CVD mainly includes atherosclerotic disease of large and medium sized
arteries and dyslipidemia being one of the most important contributing factors. Diabetes mellitus (DM) is
frequently associated with hyperlipidemia and is considered to be a major risk factor of CVD. The aim of
this study was to find out the pattern of dyslipidemia in type 2 diabetes mellitus.

Material and Methods: A Total of 144 type 2 diabetic individuals and 56 normal healthy controls were
included in this study. Serum glucose and lipid profile was measured in fasting sample.

Results: According to NCEP-ATPIII, 43 (58.1%) females were dyslipidemic and 49 (70.0%) males were
dyslipidemic. And overall prevalence of dyslipidemia was found to be 92 (63.8%).

Conclusion: A significant proportion of diabetic individuals are dyslipidemic. Male are at higher risk
group than females due to dyslipidemia. Diabetic individuals frequently have to monitor their lipid profile
to prevent themselves from the risks associated with dyslipidemia.

Keywords: Cardiovascular disease, Diabetes, Dyslipidemia, Lipid profile

Introduction Materials and Methods

Cardiovascular disease (CVD) is a leading cause
This cross-sectional study was conducted in
of death and disability in both developed as well as
Department of Biochemistry, Clinical Laboratory
developing countries.1 South Asians have the highest
Services, BP Koirala Institute of Health Sciences,
rates of coronary artery disease.2 Despite advances
Dharan, Nepal from 1st - 31st January 2008. Total 144
made in the prevention and management of CVD,
type 2 diabetic individuals and 56 normal healthy
people with diabetes mellitus (DM) continue to have
controls were included in this study.
alarmingly high morbidity and mortality secondary to
CVD.3 CVD mainly includes atherosclerotic disease
Blood sample was collected from 10-12 hr fasting
of large and medium sized arteries and dyslipidemia
subjects. Serum was separated within 30 min of
being one of the most important contributing factor.4
blood collection. Serum glucose was measured by
It has long been known that lipid abnormalities
enzymatic glucose oxidase-peroxidase method.
are major risk factors for CVD.2,5 DM is frequently
Serum total cholesterol (TC) and triglycerde (TG) level
associated with hyperlipidemia and is considered
was measured by enzymatic methods. High-density
to be a major risk factor of CVD.6,7 The aim of this
lipoprotein cholesterol (HDL-C) was measured by
study is to find out the pattern of dyslipidemia in type
precipitation followed by enzymatic methods. Low-
2 diabetes mellitus.
density lipoprotein cholesterol (LDL-C) and very-
low density lipoprotein cholesterol (VLDL-C) were
calculated by Fridewald’s formula.8
* Corresponding Author: Prashant Regmi, PG Student
For serum lipids, National Cholesterol Education
Clinical Biochemistry, Department of Biochemistry,
Programme Adult Treatment Panel III (NCEP-ATPIII)
TU Teaching Hospital, Maharajgunj, Kathmandu,
guidelines was referred.4,9 According to NCEP-ATPIII
E-mail- regmipr@hotmail.com.
guideline, hypercholesterolemia is defined as TC>200

JNAMLS I VOL 10 I NO. 1 I December, 2009 11

Regmi P et. al.
mg/dl, LDL-C as >100 mg/dl, hypertryglyceridemia
as TG >150 mg/dl and HDL-C as <40 mg/dl.
Dyslipidemaia is defined by presence of one or
more than one abnormal serum lipid concentration.
Diabetes was defined as per American Diabetes
Association (ADA) criteria.10
Statistical analysis was done using SPSS
(version13.0). Lipid and glucose levels were
expressed as mean ±SD.
Results
Total 144 type 2 diabetic individuals and 56 healthy
controls were included in this study. Among the
diabetic individuals, 74 were females and rest 70
were males. And, among the controls 28 were males
and 28 were females.
which are well-known risk factors for cardiovascular
diseases.
Several factors are likely to be responsible for diabetic
dyslipidemia: insulin effects on liver apoprotein
production, regulation of lipoprotein lipase (LpL),
action of cholesteryl ester transfer protein (CETP), and
peripheral actions of insulin on muscle and adipose
tissue. Hepatic lipase is an enzyme synthesized
by hepatocytes that hydrolyzes phospholipids and
triglycerides on HDL and remnant lipoproteins. Some
studies suggest that this enzyme is reduced by insulin
deficiency. One effect of hepatic lipase deficiency is
to decrease the clearance of remnant lipoproteins.11,12
LpL is the major enzyme responsible for conversion of
lipoprotein triglyceride into free fatty acids.13 Several
steps in the production of biologically active LpL may
be altered in diabetes mellitus.14,15

Baseline values of glucose and lipid is presented
with their SD.
Table 1: Baseline character of Diabetic subjects and
Controls
There are several reasons for the decrease in
HDL found in patients with diabetes. Increased
concentrations of plasma VLDL drive the exchange
of triglyceride from VLDL for the cholesteryl esters
found in HDL.16

Biochemical parameters
Diabetic Healthy LDL is not usually increased in diabetes. In part this
subjects controls may represent a balance of factors that affect LDL
production and catabolism. A necessary step in LDL
Mean (SD) Mean (SD)
production is hydrolysis of its precursor VLDL by
(mg/dL) (mg/dL) LpL. A reduction in this step due to LpL deficiency
or excess surface apoprotein decreases LDL
Glucose 160(55) 92(7) synthesis.17 Patients with diabetes especially type 2,
have increased VLDL production.18
Total cholesterol (TC) 189(56) 139(18)

Triglyceride (TG) 194(97) 98(11) In the study of Sehran et al 19 in Pakistan, 54%

HDL C 44(8.3) 49(5)
LDL C 105(46) 81(12)
VLDL C 38.5(19.5) 23(4)
Hypercholestrolemia was found in 51(35.4%)
individuals, similarly hypertriglyceridemia was found
in 90(62.5%) individuals, decreased HDL C was found
in 54(37.5%) individuals and increased LDL C was
found in 69(47.9%) individuals. Among the diabetic
individuals, 57 individuals had only one abnormal
lipid parameter, 24 had two abnormal lipid parameter
and 33 individuals had more than 2 abnormal lipid
parameters. According to NCEP-ATPIII , 43 (58.1%)
females out of 74 were dyslipidemic and 49 (70 %)
males out of 70 were dyslipidemic.
diabetic individuals had elevated LDL-C, >50%
individuals had increased TG. These findings are
similar to our study. But in contrast to our study, they
found decreased HDL-C in 73% individuals. Similarly
16%, 48% and 34% individuals respectively had one,
two and more than two abnormal parameters while
in our study it was 39.5, 16.6 and 23% respectively.
Study by Curtis et al20 in African-American type
2 diabetic individuals found higher LDL in 58%
individuals, low HDL-C in 41% individuals and higher
TG in about 50% individuals.
Similarly study of Rakesh et al21 in India showed
that 41% individuals had only one abnormal lipid
parameter, 44.9% had two and 14.1% had more than
two abnormal lipid parameters.

Discussion In another study conducted in India, it was shown

The aim of this study is to evaluate dyslipidemia in
diabetic individuals. The study reveals the prevalence
of hypercholesterolemia, hypertriglycerademia,
abnormally high LDL-C, and low HDL-C levels
that around 75% of patients with Myocardial
infarction (MI) had TC levels <200 mg/dl indicating
that the threshold for the TC levels above which it
poses a risk for coronary artery disease is low for
south Asians.22

12 JNAMLS I VOL 10 I NO. 1 I December, 2009


In our study dyslipidemia was higher in male
than in female. The contributing factor for
hypertriglyceridemia in our population could be our
diet rich in carbohydrates.23 High TG levels have been
associated with increased levels of small dense LDL
which are considered to be highly atherogenic.24 Diet
with high fat and calorie intake and lack of physical
activity would be the major culprits of dyslipidemia in
our population. Literatures have shown that our diets
are rich in saturated fats. Besides it also involves
overcooking of food which results in destruction of
nutrients like folate, deep frying and refrying in the
same oil leading to trans-fatty acid formation which
probably contributes to increase of dyslipidemia in
our population.25
Conclusion
Dyslipidemia in diabetes is a major problem and
a major risk factor for cardiovascular diseases. A
significant proportion of diabetic individuals are
dyslipidemic. Males were found to be at higher risk
of developing dyslipidemia than females. Diabetic
individuals frequently have to monitor their lipid profile
to prevent themselves from the risks associated with
dyslipidemia as in this study 92 (63.8%) of diabetic
subjects were found to have dyslipidemia.
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