Glycated Hemoglobin: Predictor of Dyslipidemia and Atherogenicity in Diabetes Mellitus

Background: Cardiovascular disease (CVD) is the major cause of morbidity/mortality in diabetes. Type 2 diabetes has an increased prevalence of lipid abnormalities contributing to their high risk of CVD. Individuals with coexisting diabetes and dyslipidemia are often soft targets for CVD and deaths. A timely intervention to normalize circulating lipids has shown to reduce cardiovascular complications and mortality. Glycosylated hemoglobin (HbA1c) is routinely used as a marker to indicate long-term glycemic control. The atherogenic index of plasma (AIP) [a logarithmic transformation of the ratio of the molar triglyceride (TAG) concentration and high density lipoprotein cholesterol (HDL)], Risk ratio (RR) [Total Cholesterol(TC)/ HDL] & Non HDL-cholesterol (NHC) [TC-HDL] have recently been proposed as a predictive marker for plasma atherogenicity. This study intends to evaluate the diagnostic value of HbA1c in predicting diabetic dyslipidemia and atherogenisity.

Methods: A total of 1217 diagnosed type II diabetic patients, who attended Tribhuvan University Teaching Hospital, Kathmandu, Nepal between January 2013 and November 2014 were recruited in the study. Fasting venous blood samples were collected. The whole blood and sera were analyzed for HbA1c, fasting blood glucose (FBG) and lipid profile panel test. Diabetes and dyslipidemia were defined as per American diabetes association criteria and National Cholesterol Education Programme (NCEP) Adult Treatment Panel (ATP) III guidelines respectively. RR, NHC and AIP were calculated. The statistical analysis was done by SPSS statistical package version 17.0.

Results: HbA1c showed direct correlation with FPG, Triacylglycerol (TAG) & Low density lipoprotein (LDL) while there was inverse correlation with HDL. Statistically significant ’p’ values (<0.05) were obtained for FPG, TAG and LDL. Closer associations were found between HbA1c and NHC and AIP than lipids alone.

Conclusion: These findings indicate that HbA1c can provide valuable supplementary information about cardiac risk besides its primary role in monitoring long-term glycemic control.