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BRIEF COMMUNICATION
Year : 2012  |  Volume : 16  |  Issue : 8  |  Page : 434-435

Dyslipidemia, metabolic syndrome, and liver enzymes in impaired glucose tolerance and new onset untreated, type 2 diabetes Indian subjects


1 Consultant Endocrinologist, KPC Medical College, RTIICS, Kolkata, India
2 Department of Endocrinology and Metabolism, IPGME & R and SSKM Hospital, Kolkata, India
3 Department of Endocrinology and Metabolism, Calcutta Medical College and Hospital, Kolkata, India

Date of Web Publication4-Jan-2013

Correspondence Address:
Debmalaya Sanyal
36, Block, H, New Alipore, Kolkata - 700 053
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.104121

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   Abstract 

This cross-sectional clinic-based study assessed and compared lipid profile, presence of metabolic syndrome (MetS), and liver enzymes in subjects with IGT, new onset treatment naive T2DM, and normal glucose tolerance (NGT). Introduction: Type 2 diabetes (T2D) and IGT patients have increased dyslipidemia, MetS, and alterations in liver enzymes. Aims and Objectives: To assess and compare lipid profile, presence of MetS, and liver enzymes in subjects with IGT, new onset treatment naοve T2DM, and NGT. Materials and Methods: This cross-sectional clinic-based study examined 152 IGT and 158 recently detected T2D subjects aged between 30 and 69 years, never treated with any anti-hyperglycemic, anti-hypertensive, and lipid lowering drugs. One hundred and sixty age- and gender-matched controls with NGT were also selected. Anthropometry, lipid profile, dyslipidemia (ADA criteria), presence of MetS (NCEP, IDF), liver enzymes, insulin resistance (HOMA-IR and QUICKI), and β-cell function (HOMA β) were analyzed in all subjects. Results: T2D and IGT subjects had significantly higher BMI, waist circumference, blood pressure (BP), HOMA-IR, QUICKI, fasting insulin, HOMA-β, MetS, triglyceride, LDL-C, SGPT, GGT, and lower HDL-C compared to NGT (control). High LDL-C (>100 mg/dl) was the commonest dyslipidemia followed by low HDL-C and hypertriglyceridemia in IGT and T2D. We found no significant differences in BMI, waist circumference, insulin resistance, total/LDL-C/HDL-C, and presence of MetS between T2D and IGT subjects. Diabetics exhibited significantly higher BP, triglyceride, SGPT, GGT, lower fasting insulin, and HOMA-β-cell function compared to IGT. Conclusions: IGT and recent onset T2D individuals had similar increased cardiovascular risk markers, liver enzymes, and prevalence of MetS. High LDL-C was the commonest dyslipidemia in IGT and T2D. T2D subjects had higher triglyceride, BP, SGPT, GGT compared to IGT.

Keywords: Liver enzymes, lipid profile, metabolic syndrome, IGT, T2DM


How to cite this article:
Sanyal D, Ghosh S, Mukherjee P, Mukherjee S, Chowdhury S. Dyslipidemia, metabolic syndrome, and liver enzymes in impaired glucose tolerance and new onset untreated, type 2 diabetes Indian subjects. Indian J Endocr Metab 2012;16, Suppl S2:434-5

How to cite this URL:
Sanyal D, Ghosh S, Mukherjee P, Mukherjee S, Chowdhury S. Dyslipidemia, metabolic syndrome, and liver enzymes in impaired glucose tolerance and new onset untreated, type 2 diabetes Indian subjects. Indian J Endocr Metab [serial online] 2012 [cited 2020 Nov 24];16, Suppl S2:434-5. Available from: https://www.ijem.in/text.asp?2012/16/8/434/104121


   Introduction Top


Type 2 diabetes (T2D) and IGT patients have increased dyslipidemia, metabolic syndrome (MetS), and alterations in liver enzymes. The aim of this study was to assess and compare lipid profile, presence of MetS, and liver enzymes in subjects with IGT, new onset treatment naοve T2DM, and normal glucose tolerance (NGT) subjects.


   Materials and Methods Top


This cross-sectional clinic-based study, at a tertiary care teaching institute in eastern India, examined 152 IGT and 158 recently detected T2D subjects aged between 30 and 69 years, never treated with any anti-hyperglycemic, anti-hypertensive, lipid lowering drugs. One hundred and sixty age- and gender-matched controls (willing healthy spouse or unrelated attendants of patients) with NGT were also selected. Patients with osmotic symptoms, history of ketosis, weight loss of >3 kg in preceding 3 months, microvascular complications, recent (<1 year) MI, acute coronary syndrome, stroke, severe co-morbid diseases (cancer and renal failure), alcohol consumption, known liver disease, ALT >3 times normal were excluded. Anthropometric measurements included weight, height, waist circumferences (WC), and BMI. Fasting plasma glucose, insulin, lipid profile, liver enzymes, dyslipidemia (ADA criteria), presence of MetS (NCEP, IDF), liver enzymes, HBsAg, anti-HCV antibody, 75-g OGTT (non-diabetics), indirect measures of insulin resistance (HOMA-IR and QUICKI), and β-cell function (HOMA β) were analyzed. Results were expressed as means ΁ standard deviation. Comparison between parameters was assessed using unpaired "t0"-test and Chi-square test.


   Results Top


Two hundred and sixty-three (56%) of study subjects were females, whereas 207 (44%) were males. Characteristics of three different groups are depicted in [Table 1].

T2D and IGT subjects had significantly higher BMI, WC, blood pressure (BP), HOMA-IR, QUICKI, fasting insulin, HOMA-β-cell function, MetS (more with IDF criteria), triglyceride, LDL-C, and lower HDL-C compared to NGT (control). IGT and diabetes patients compared to control had significant higher prevalence of hypertriglyceridemia and low HDL-C with diabetic subjects having higher prevalence and more severe dyslipidemia. High LDL-C (>100 mg/dl) was the commonest dyslipidemia followed by low HDL-C and hypertriglyceridemia in IGT and T2D subjects. Diabetic and IGT cohorts compared to NGT had significantly higher SGPT and GGT but no difference in ALP and SGOT. We found no significant differences in BMI, WC, insulin resistance, total/LDL/HDL cholesterol, and MetS between T2D and IGT subjects. Diabetics exhibited significantly higher BP, triglyceride, SGPT, GGT, lower fasting insulin, and HOMA-β-cell function compared to IGT.


   Discussion Top


There is a high prevalence of dyslipidemia, MetS, and alterations in liver enzymes in IGT and T2D. In UKPDS study, triglyceride was substantially increased; HDL-C was markedly reduced in T2D compared to controls. [1] However, total cholesterol in T2D did not differ with controls though diabetic women had markedly higher LDL-C. [1] An Indian study by Parikh et al. found that majority of Indian T2D patients were dyslipidemic at baseline, the most common pattern of dyslipidemia was high LDL-C followed by low HDL-C. [2] Fifty-seven percent of IGT patients in Diabetes prevention program (DPP) study cohort had low HDL, more than 40% had raised LDL-C and triglyceride. [3] In our study, high LDL-C (>100 mg/dl) was the commonest dyslipidemia followed by low HDL-C and hypertriglyceridemia in both IGT and T2D subjects. Tankova et al. recorded that the prevalence of MetS (IDF) in IGT (89.1%) was similar to that in newly diagnosed T2D (89.51%). [4] We had similar high prevalence of MetS in 60.8% of IGT and 69.2% of T2D patients by IDF criteria, much higher than by NCEP criteria. Several studies have reported higher prevalence when using 2005 IDF definition as compared to WHO and ATP III criteria. [4] The Shanghai Diabetes Study found that ALT and GGT were closely related to pre-diabetes and diabetes in Shanghai population. [5] In our study, T2D and IGT cohorts compared to NGT had significantly higher SGPT and GGT but no difference in ALP and SGOT.

In conclusion, IGT and recent onset T2D individuals had similar increased cardiovascular risk markers, liver enzymes, and prevalence of metabolic syndrome. In our study, high LDL-C was the commonest dyslipidemia in both IGT and T2D. So IGT should be considered not just as a condition of altered glucose metabolism but also in relation to their association with cardiovascular risk factors. Our T2D subjects had impaired β-cell function and higher triglyceride, BP, SGPT, and GGT compared to IGT.

 
   References Top

1.U.K. Prospective diabetes study 27. Plasma lipids and lipoproteins at diagnosis of NIDDM by age and sex. Diabetes Care 1997;20:1683-7.  Back to cited text no. 1
    
2.Parikh RM, Joshi SR, Menon PS, Shah NS. Prevalence and pattern of diabetic dyslipidemia in Indian type 2 diabetic patients. Diabetes Metab Syndr 2010;4:10-2.  Back to cited text no. 2
    
3.Diabetes Prevention Program Research Group. Lipid, lipoproteins, C-reactive protein, and hemostatic factors at baseline in the diabetes prevention program. Diabetes Care 2005;28:2472-9.  Back to cited text no. 3
[PUBMED]    
4.Tankova TI, Chakarova NY, Dakovska LN, Kalinov KB, Atanassova IA. Assessment of the risk for metabolic syndrome in prediabetes and newly-diagnosed type 2 diabetes. J Diabetology 2010;2:5.  Back to cited text no. 4
    
5.Gao F, Pan JM, Hou XH, Fang QC, Lu HJ, Tang JL, et al. Liver enzymes concentrations are closely related to prediabetes: Findings of the Shanghai Diabetes Study II (SHDS II). Biomed Environ Sci 2012;25:30-7.  Back to cited text no. 5
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