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

UNLABELLED: 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 naïve 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 naïve 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.

INTRODUCTION

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 naïve T2DM, and normal glucose tolerance (NGT) subjects.

MATERIALS AND METHODS

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 “t”-test and Chi-square test.

RESULTS

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

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.