Mengesha, Addisu Y

South African Medical Journal (SAMJ)

ORIGINAL ARTICLES147February 2006, Vol. 96, No. 2  SAMJHyperlipidaemia has been incriminated as a risk factor in coronary heart disease (CHD) and atherosclerosis,1,2 in addition to other risk factors including diabetes mellitus (DM). DM affects several lipid metabolism mechanisms. Low insulin levels in type 1 DM are associated with high levels of chylomicrons and very-low-density lipoprotein (VLDL) and lipoprotein lipase deficiency, resulting in hypertriglyceridaemia. Such hyperlipidaemia improves with tighter control of type 1 DM. Obesity and insulin resistance result in hypertriglyceridaemia due to overproduction of VLDL. Management of hyperlipidaemia in type 2 DM involves rigorous dietary and drug treatment. Treatment of hyperlipidaemia has been shown to benefit DM patients in decreasing CHD risk.2-4   In a study of DM patients in Ethiopia,5 18.5% and 14.2% were found to have hypercholesterolaemia and hypertriglyceridaemia respectively. In the same study hypercholesterolaemia was found in a high proportion of females and type 2 DM patients. In a report from the third US National Health and Nutrition Examination Survey and the Behavioral Risk Factors Surveillance System6 which monitored 4 085 adults with diabetes, 58% had serum low-density lipoprotein (LDL) cholesterol levels greater than or equal to 3.4 mmol/l. Of the 2 481 patients aged over 45 years studied in the UK to assess the universal screening of diabetes in general practice, 73% (45 - 92%) had a cholesterol level > 5 mmol/l.7 In a cross-sectional survey in South Africa8 undertaken to assess dietary patterns in type 2 DM patients (133 men, 155 women), high triglyceride levels were detected in 24 - 25% of men and in 17 - 18% of women. Subjects and methodsA cross-sectional study was carried out in Gaborone, Botswana. The study subjects were all DM patients receiving diabetic care at 14 Gaborone City Council (GCC) clinics. A medical officer examined the patients and administered a questionnaire, and patients were sent for laboratory investigations. Glycosylated haemoglobin, serum cholesterol, triglyceride, high-density lipoprotein (HDL) and LDL levels were determined by the Botswana National Laboratory using Cobas Integra 400. The study period was between 1 December 2003 and 28 February 2004. All subjects who gave consent were included in the study.    Overweight was defined as a body mass index (BMI) > 25 up to 30 and obesity as BMI > 30. Hypercholesterolaemia was defined as total cholesterol > 5.3 mmol/l, while hypertriglyceridaemia was defined as > 1.82 mmol/l.   The questionnaire was coded and analysed using EpiInfo 2002. Analysis of variance (ANOVA), t-test, chi-square test, correlation and regression analysis were used. PubMed was used to search for the relevant literature.ResultsFour hundred and one patients with DM participated in the study, of whom 287 (71.6%) were female and 114 (28.4%) male. The mean age of the subjects was 53.8 years (standard deviation (SD) 12.2 years). The mean glycosylated haemoglobin was 9.56% (SD 2.6%). Of the subjects 61.2% had hypertension, 27.2% were overweight (BMI > 25 up to 30), 56.4% were obese (BMI > 30), 4% had a history of smoking and 3.1% had a history of alcohol intake. Only 13.7% did regular exercise.   The mean serum cholesterol level was 4.9 mmol/l and 33.5% of the subjects had serum cholesterol levels higher than 5.3 mmol/l. There was no difference (p = 0.17) in mean serum cholesterol level between males (4.99 mmol/l) and females (4.77 mmol/l). There was no significant difference in mean Lipid profile among diabetes patients in Gaborone, BotswanaAddisu Y Mengesha Gaborone City Council, Health Department, PO Box 46318, Gaborone, BotswanaAddisu Y Mengesha, MDCorresponding author: A Y Mengesha (addisuyilma@yahoo.com)A cross-sectional study was undertaken to determine the serum lipid profile of diabetes mellitus (DM) patients receiving treatment at Gaborone City Council clinics. A total of 401 patients were studied over a 3-month period. It was found that 33.5% had hypercholesterolaemia and 38.9% hypertriglyceridaemia. The mean low-density lipoprotein (LDL) levels were higher in females than in males, but there was no difference in LDL levels between type 1 and 2 DM patients. There was no difference in cholesterol, triglyceride and high-density lipoprotein (HDL) levels between genders or between type 1 and 2 patients. Hyperlipidaemia was associated with high body mass index. Only hypertriglyceridaemia was associated with high blood pressure. Hyperlipidaemia was not associated with exercise, smoking or alcohol consumption in the DM patients studied.S Afr Med J 2006; 96: 147-148.pg 147-148.indd   147 1/17/06   4:20:28 PMFebruary 2006, Vol. 96, No. 2  SAMJORIGINAL ARTICLES148HbA1c between DM patients with normal cholesterol levels and those with hypercholesterolaemia (p = 0.45). The mean serum triglyceride level was 1.79 mmol/l; 38.9% of DM patients had serum triglyceride levels higher than 1.82 mmol/l. There was no difference (p = 0.09) in mean serum triglyceride level between males (1.73 mmol/l) and females (1.92 mmol/l). There was no difference between type 1 and type 2 DM patients with regard to serum cholesterol (p = 0.77) or triglyceride levels (p = 0.22). There was no significant difference in mean HbA1c between DM patients with normal triglyceride levels and those with hypertriglyceridaemia (p = 0.07).   The mean HDL level was 1.27 mmol/l; 11.4% of patients had an HDL level above 1.6 mmol/l. There was no difference in HDL levels between males and females (p = 0.64) or between type 1 and 2 DM patients (p = 0.99). The mean LDL level was 3.44 mmol/l; 58.2% of patients had an LDL level higher than 3.36 mmol/l. LDL levels were higher in females (3.54 mmol/l) than males (3.14 mmol/l) (t = 2.01, p = 0.04), but there was no difference in LDL levels between type 1 and 2 DM patients  (p = 0.87).   Hypercholesterolaemia was associated with overweight (r^2 = 0.03, F = 6.88, p = 0.009) and obesity (r^2 = 0.03, F = 8.02, p = 0.0048). Hypertriglyceridaemia was associated with overweight (r^2 = 0.03, F = 6.79, p = 0.0095) and obesity (r^2 = 0.03, F = 7.7, p = 0.0057). Hyperlipidaemia was not associated with exercise, smoking or alcohol consumption. Variables included in the regression were age, sex, BMI, serum lipid levels, hypertension, alcohol consumption, smoking and exercise.DiscussionIn the study about one-third of the DM patients had hypercholesterolaemia and about half had hypertriglyceri-daemia. This finding is higher than other reports from Africa,5,8 but lower than reports from the UK.7 Similar to the findings of a USA survey,6 the majority of DM patients had LDL levels higher than 3.36 mmol/l, which is considered to pose a risk of CHD and atherosclerosis. Only a few of the DM patients were found to have HDL levels higher than 1.6 mmol/l, which is associated with low risk of CHD and atherosclerosis. When such lipid profiles co-exist with high levels of overweight and obesity among DM patients, a high incidence of CHD and atherosclerosis may be inevitable in the future.    The study showed that obesity is strongly associated with elevated plasma lipid levels. Hyperlipidaemia was not associated with exercise, smoking or alcohol consumption. Except for LDL levels, which tend to be higher in female DM patients, there was no significant difference between males and females with regard to the other plasma lipid levels.ConclusionHyperlipidaemia is a common finding among DM patients. DM patients should be screened and appropriate management should be instituted to reduce the risk of CHD and atherosclerosis. Further studies should be undertaken to establish dietary patterns in Botswana and other factors that may lead to hyperlipidaemia.   Acknowledgement: Ministry of Health Research Unit and Gaborone city council clinics.References1.  Krentz AJ. Lipoprotein abnormalities and their consequences for patients with type 2 diabetes: Diabetes Obes Metab 2003; 5: Suppl 1, S19-27.2.  Holman R. The UKPDS: implications for the dyslipidaemic patient. Acta Diabetol 2001; 38: Suppl 1, S9-14.3.  Sacks FM, Tonkin AM, Craven T, et al. Coronary heart disease in patients with low LDL-cholesterol: benefit of pravastatin in diabetics and enhanced role for HDL-cholesterol and triglyceride as risk factors. Circulation 2002; 105: 1424.4.  Manley SE, Stratton IM, Cull CA, et al. Effects of three months' diet after diagnosis of Type 2 diabetes on plasma lipids and lipoproteins (UKPDS 45). UK Prospective Diabetes Study Group. Diabet Med 2000; 17: 518-523.5.  Seyoum B, Abdulkadir J, Berhanu P, et al. Analysis of serum lipids and lipoproteins in Ethiopian diabetic patients. Ethiop Med J 2003; 41(1): 1-8.6.  Saaddine JB, Engelgau MM, Beckles GL, et al. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med 2002; 136: 565.7.  Lawrence JM, Bennett P, Young A, Robinson AM. Primary care screening for diabetes in general practice: cross sectional population study. BMJ 2001; 323: 548-551.8. Nthangeni G, Steyn NP, Alberts M, et al. Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health-care services. Public Health Nutr 2002; 5: 329-338.Accepted 5 October 2005.Table I.  Mean serum lipid levels among male and female diabetes mellitus patients in Gaborone City Council clinics, Gaborone, Botswana, 2004  Cholesterol Triglyceride HDL LDL  N (%) (mmol/l) (mmol/l) (mmol/l) (mmol/l)Male         114 (28.4)   4.99 1.82 Mean   3.14Female     287 (71.6)   4.77 1.92 1.27   3.54   Total        401   (NS) pg 147-148.indd   148 1/17/06   4:20:29 PM

Lipid profile among diabetes patients in Gaborone, Botswana

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Lipid profile among diabetes patients in Gaborone, Botswana

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