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WEERARATHNA TP, LEKAMWASAM S, KODIKARA I, WASANA KGP, FONSEKA L. Control of cardiometabolic risk factors and their association with carotid intima media thickness among patients with type 2 diabetes mellitus-single center experience in a developing country. Turk J Med Sci 2024; 54:545-554. [PMID: 39050007 PMCID: PMC11265882 DOI: 10.55730/1300-0144.5821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/12/2024] [Accepted: 01/11/2024] [Indexed: 07/27/2024] Open
Abstract
Background/aim Type 2 diabetes mellitus (T2DM) is closely associated with atherosclerotic cardiovascular diseases (ASCVD). The objective of this study was to describe the degree of ASCVD risk factor control and their association with carotid intima-media thickness (CIMT) in T2DM patients followed up at a diabetes clinic in Southern, Sri Lanka. Materials and methods A crosssectional study was conducted to examine the association between CIMT and nonalcoholic fatty liver disease (NAFLD)in 300 T2DM patients. Both CIMT and its associations with modifiable cardiometabolic risk factors were examined using ultrasonography. The recommended optimal targets for risk factors were defined as glycated hemoglobin (HbA1C) < 7 %, absence of NAFLD, albumin-to-creatinine ratio (ACR) < 30 mg, triglyceride (TG) < 150 mg/dL, low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, high-density lipoprotein cholesterol (HDL-C) in men > 40 and in women > 50 mg/dL, systolic blood pressure (SBP) < 130 mmHg, and diastolic blood pressure (DBP) < 80 mmHg. Results SBP, DBP, LDL-C, TG, HDL-C, HbA1C, and ACR were optimally controlled in 59.3%, 75.0%, 46.7%, 84.3%, 46.0%, 33.0%, and 18.7% of patients, respectively. Notably, nearly half of the study subjects did not have NAFLD. Only three patients (1%) had achieved all therapeutic targets. There were statistically significant differences in CIMT between optimally controlled TG and suboptimally controlled TG group (p = 0.027) and between the groups with and without NAFLD (p = 0.045) when adjusted for age and duration of diabetes. CIMT showed significant and positive associations with LDL-C (p = 0.024), TG (p = 0.026), and NAFLD (p = 0.005). Among these, the presence of NAFLD had the highest odds of having higher CIMT when compared to LDL-C and TG. Conclusion The majority of patients have not achieved the recommended targets for ASCVD risk factors and are at high risk of ASCVD. It is therefore necessary to identify the reasons for not achieving the treatment targets in order to reduce the ASCVD burden by controlling LDL-C, TG, and NAFLD.
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Affiliation(s)
| | - Sarath LEKAMWASAM
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle,
Sri Lanka
| | - Iroshani KODIKARA
- Department of Anatomy, Faculty of Medicine, University of Ruhuna, Galle,
Sri Lanka
| | | | - Lakmal FONSEKA
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle,
Sri Lanka
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Chahine B, Souheil FA, Hanna V. Prescription patterns of antidiabetic and cardiovascular preventive medications in community-dwelling older adults with type 2 diabetes mellitus: a cross-sectional study. J Geriatr Cardiol 2023; 20:867-876. [PMID: 38161340 PMCID: PMC10755210 DOI: 10.26599/1671-5411.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE To describe trends in antidiabetics drug prescription patterns in community-dwelling older adults with type 2 diabetes mellitus (T2DM) and to evaluate the use of cardiovascular preventive medications among those diagnosed with atherosclerotic cardiovascular disease (ASCVD). METHODS This cross-sectional, face-to-face interview study that comprised community-dwelling older adults (≥ 65 years) diagnosed with T2DM. The study questionnaire included the patients' demographics, clinical data, and current medication use. Patients with established ASCVD were further classified into low (i.e., not receiving evidence-based therapy or only one) and high (i.e., receiving at least two evidence-based therapies) composite score groups. Bivariate analysis followed by multivariable logistic regression analysis were performed to evaluate the demographic/clinical characteristics associated with the use of antidiabetic monotherapy/polytherapy and evidence-based pharmacotherapy. RESULTS A total of 500 older adults were enrolled. The mean age of included participants was 73 ± 7 years, 310 participants (62%) were males, and 385 participants (77.0%) had established ASCVD. Antidiabetic monotherapy was reported in 251 participants (50.2%), with metformin followed by sulfonylureas being the most commonly prescribed drugs as monotherapy. The results of the multivariable analysis showed that age [odds ratio (OR) = 0.89, 95% CI: 0.85-0.94, P < 0.001], obesity (OR = 4.18, 95% CI: 1.63-10.36, P = 0.003), hypertension (OR = 4.2, 95% CI: 1.22-7.66, P = 0.04), and dyslipidemia (OR = 4.1, 95% CI: 1.28-8.30, P = 0.01), were significantly associated with the prescription of cardiovascular preventive medications. CONCLUSIONS Only one in twenty-one participant with T2DM and ASCVD collectively received three guideline-recommended therapies, indicating a deficiency of utilization of cardiovascular preventive drugs.
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Affiliation(s)
- Bahia Chahine
- Lebanese International University, School of Pharmacy, Beirut, Lebanon
| | - Farah Al Souheil
- Lebanese International University, School of Pharmacy, Beirut, Lebanon
| | - Venise Hanna
- Lebanese International University, School of Pharmacy, Beirut, Lebanon
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Bage IJ, Kamalanathan S, Selvarajan S, Sahoo J, Jayanthi M, Naik D. The Association of Dyslipidemia and Atherogenic Indices With Glycemic Control in Diabetic Dyslipidemia Patients: A Real-World Landscape. Cureus 2023; 15:e45985. [PMID: 37900537 PMCID: PMC10601505 DOI: 10.7759/cureus.45985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Dyslipidemia is an important comorbid factor of type 2 diabetes mellitus (T2DM) that increases the risk of cardiovascular diseases. This study aimed to assess the pattern of dyslipidemia and atherogenic indices and determine its relation with glycemic control. METHODS A cross-sectional study enrolled 382 patients with diabetic dyslipidemia. The socio-demographics data, clinical features, and laboratory parameters were collected. The baseline lipid parameters such as total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and glycated hemoglobin (HbA1C) were measured. Atherogenic indices such as TC/HDL-C ratio, TG/HDL-C ratio, LDL-C/HDL-C ratio, non-HDL-C/HDL-C and atherogenic index of plasma (AIP) [log10 (TG/HDL-C)] were calculated. T2DM patients were classified into three groups based on the degree of glycemic control: Good glycemic control (HbA1C<7%), fair control (HbA1C 7-8%), and poor control (HbA1C>8%). RESULTS The population's mean age was 48.60±6.15 years, with 145 (38%) males. We found mixed dyslipidemia as the most prevalent (36.1%) form of dyslipidemia in our patients. The most common pattern in atherogenic indices was AIP (94.2%). HbA1c was positively correlated with duration of diabetes (r=0.253, p<0.001). In multivariate logistic regression analysis, duration of diabetes (>10 years) was significantly associated with poor glycemic control with an odds ratio (OR) of 2.31(95% CI; 1.25-4.24, p=0.007). CONCLUSION The present study indicated that neither the pattern of dyslipidemia nor the atherogenic indices were markers of poor glycemic control among South Indian patients attending our tertiary care institute. However, duration of diabetes was significantly associated with poor glycemic control.
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Affiliation(s)
- Isaac J Bage
- Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sadishkumar Kamalanathan
- Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sandhiya Selvarajan
- Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Jayaprakash Sahoo
- Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Mathaiyan Jayanthi
- Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Dukhabandhu Naik
- Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Hiremath J, Mohan JC, Hazra P, Sawhney JS, Mehta A, Shetty S, Oomman A, Shah MK, Bantwal G, Agarwal R, Karnik R, Jain P, Ray S, Das S, Jadhao V, Suryawanshi S, Barkate H. Bempedoic Acid for Lipid Management in the Indian Population: An Expert Opinion. Cureus 2023; 15:e35395. [PMID: 36987470 PMCID: PMC10040092 DOI: 10.7759/cureus.35395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
Lipid-lowering is a central theme in the management of patients with atherosclerotic cardiovascular disease (ASCVD) and heterozygous familial hypercholesterolemia (HeFH), with statins being currently used as the first-line lipid-lowering agent (LLAs). Bempedoic acid (BA) has been recently approved for lipid management in ASCVD/HeFH patients. This expert opinion paper brings out the essential concept to assess the current place of BA in the Indian population. Here we highlight that the majority of the patients with clinical ASCVD may not be receiving the optimal dose of statin, thereby failing to achieve their lipid targets. The addition of BA to statin results in a significant reduction in low-density lipoprotein cholesterol (LDL-C) along with substantial reductions in non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (ApoB), and high-sensitivity C-reactive protein (hsCRP) levels. For patients who do not achieve LDL-C targets, BA can be an effective add-on alternative to choose among non-statin LLAs. BA is a good choice for statin-intolerant cases, especially in combination with ezetimibe. Given the lack of effect of worsening hyperglycemia or any increase in the occurrence of new-onset diabetes, BA can be used without hesitation in patients with diabetes. The small risk of hyperuricemia could be mitigated with appropriate patient selection and monitoring of serum uric acid levels in patients at high risk of hyperuricemia. We believe BA is an excellent non-statin therapy that is efficacious, well-tolerated, and cost-effective for lipid management in ASCVD, HeFH, and statin-intolerant patients in India.
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Affiliation(s)
| | - J C Mohan
- Cardiology, Jaipur Golden Hospital, Jaipur, IND
| | - Prakash Hazra
- Cardiology, Apollo Clinic Hospitals, Ballygunge, Kolkata, IND
| | - Jp S Sawhney
- Cardiology, Sir Ganga Ram Hospital, New Delhi, IND
| | | | - Sadanand Shetty
- Cardiology, Sadanand Healthy Living Center (P) Ltd. Sion (East), Mumbai, IND
| | | | - Mahesh K Shah
- Cardiology, MK's Heart Care, Vile Parle, Mumbai, IND
| | - Ganapathi Bantwal
- Endocrinology, Diabetes and Metabolism, St. John's Medical College and Hospital, Bengaluru, IND
| | | | - Rajiv Karnik
- Cardiology, Dr. Karnik's Cardiac Clinic, Mulund West, Mumbai, IND
| | - Peeyush Jain
- Cardiology, Fortis-Escorts Heart Institute and Research Centre, Delhi, IND
| | - Saumitra Ray
- Cardiology, Woodlands Multispeciality Hospital, Kolkata, IND
| | - Sambit Das
- Endocrinology, HiTech Medical College and Hospitals, Bhubaneshwar, IND
| | - Vibhuti Jadhao
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | | | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
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Hyassat D, Al-Saeksaek S, Naji D, Mahasneh A, Khader Y, Abujbara M, El-Khateeb M, Ajlouni K. Dyslipidemia among patients with type 2 diabetes in Jordan: Prevalence, pattern, and associated factors. Front Public Health 2022; 10:1002466. [PMID: 36424970 PMCID: PMC9679519 DOI: 10.3389/fpubh.2022.1002466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives To determine the prevalence and patterns of dyslipidemia and its associated risk factors among patients with type 2 diabetes attending the National Center for Diabetes, Endocrinology, and Genetics (NCDEG). Methods A cross-sectional study was conducted at the NCDEG in Amman, Jordan. A total of 971 patients with type 2 diabetes were included during the period September- December 2021. The socio-demographic data were collected through face-to-face interview questionnaire and anthropometric and clinical data were abstracted from medical records. The last three readings of lipid profile and HbA1C were abstracted from the medical records. Results The overall prevalence of dyslipidemia among type 2 diabetic patients was 95.4%. The most common type of dyslipidemia was combined dyslipidemia (37.1%), with high triglycerides and low HDL-c (19.0%) being the most frequent type. Factors associated with hypercholesterolemia were diabetes duration ≤ 10 years, poor compliance to a statin, and HbA1c level (7-8%) (P-values: 0.008, 0.001, 0.021, respectively). Moreover, smoking and poor compliance with statin therapy were associated with high LDL-c level (P-values: 0.046 and 0.001, respectively). The presence of hypertension, high waist circumference, HbA1c level >8%, and diabetes duration ≤ 10 years were all associated with high triglyceride level (P-values: 0.008, 0.016, 0.011, and 0.018, respectively). Hypertension and HbA1c level >8% were associated with low HDL-c level (P-values: 0.010 and 0.011, respectively). Conclusion The combination of high triglyceride and low HDL-c is the commonest lipid abnormality detected in patients with type 2 diabetes. An educational program that emphasizes the importance of adherence to a healthy lifestyle is strongly recommended. Further studies are needed to capture a wide range of factors that might influence dyslipidemia and glycemic control.
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Affiliation(s)
- Dana Hyassat
- The National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
| | - Saba Al-Saeksaek
- The National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
| | - Duha Naji
- The National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
| | - Awn Mahasneh
- The National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
| | - Yousef Khader
- Department of Public Health, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Mousa Abujbara
- The National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
| | - Mohammad El-Khateeb
- The National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
| | - Kamel Ajlouni
- The National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan,*Correspondence: Kamel Ajlouni
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Liu H, Liu J, Liu J, Xin S, Lyu Z, Fu X. Triglyceride to High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio, a Simple but Effective Indicator in Predicting Type 2 Diabetes Mellitus in Older Adults. Front Endocrinol (Lausanne) 2022; 13:828581. [PMID: 35282431 PMCID: PMC8907657 DOI: 10.3389/fendo.2022.828581] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/31/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A simple and readily available biomarker can provide an effective approach for the surveillance of type 2 diabetes mellitus (T2DM) in the elderly. In this research, we aim to evaluate the role of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio as an indicator for new-onset T2DM in an elderly Chinese population aged over 75 years. METHODS This longitudinal retrospective cohort study was conducted using a free database from a health check screening project in China. Participants with baseline TG and HDL measurements were enrolled, and the data of T2DM development were collected. The cumulative incident T2DM rates in different quintile groups of TG/HDL-C ratio (Q1 to Q5) were calculated and plotted. The independent effect of baseline TG/HDL-C ratio on T2DM risk during the follow-up period was tested by the Cox proportional hazard model. Subgroup analysis was also conducted to clarify the role of TG/HDL-C ratio in specific populations. RESULTS A total of 231 individuals developed T2DM among 2,571 subjects aged over 75 years during follow-up. Regardless of adjustment for potential confounding variables, elevated TG/HDL-C ratio independently indicated a higher risk of incident T2DM [hazard ratio (HR) = 1.29; 95% confidence interval (CI), 1.14-1.47; P < 0.01. As compared with the lowest quintile (Q1), elevated TG/HDL-C ratio quintiles (Q2 to Q5) were associated with larger HR estimates of incident T2DM [HR (95% CI), 1.35 (0.85-2.17), 1.31 (0.83-2.06), 1.85 (1.20-2.85), and 2.10 (1.38-3.20), respectively]. In addition, a non-linear correlation was found between TG/HDL-C ratio and the risk of T2DM, and the slope of the curve decreased after the cutoff point of 2.54. Subgroup analysis revealed a stronger positive correlation among male individuals and those with body mass index <24 kg/m2. CONCLUSIONS Increased TG/HDL-C ratio indicates a greater risk of new-onset T2DM regardless of confounding variables. TG/HDL-C ratio is a simple but effective indicator in predicting T2DM in older adults. More future investigations are warranted to further promote the clinical application of TG/HDL-C ratio.
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Affiliation(s)
- Hongzhou Liu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Endocrinology, First Hospital of Handan City, Handan, China
| | - Jing Liu
- Clinics of Cadre, Department of Outpatient, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jixiang Liu
- Department of Cerebral Surgery, First Hospital of Handan City, Handan, China
| | - Shuanli Xin
- Department of Cardiology, First Hospital of Handan City, Handan, China
| | - Zhaohui Lyu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Xiaomin Fu, ; Zhaohui Lyu,
| | - Xiaomin Fu
- Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Xiaomin Fu, ; Zhaohui Lyu,
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