Plasma glucose, HbA1c, insulin and lipid profile in Sudanese type 2 diabetic patients with cardiovascular disease: a case control study

Introduction

T2DM has no established cause, however it is known to be caused by physiological, genetic, and environmental variables such as obesity, family history, and pollution (Yang et al., 2018). T2DM and its consequences are a major global public health issue, and cardiovascular disease (CVD) represents a significant health burden in Sub-Saharan Africa, including Sudan (Almobarak et al., 2018).

In fact, T2DM and CVD share several risk factors, such as obesity, hypertension, hyperglycemia, insulin resistance, serum lipid and lipoprotein abnormalities, which are defined mostly by high serum triglycerides and low levels of high-density lipoprotein (HDL) cholesterol (Rosa et al., 2018; Vepsäläinen, 2013) Hypertension in people with diabetes increases the risk of peripheral arterial disease, as well as dyslipidaemia, which is a significant risk factor for developing macrovascular complications in diabetic patients and contributes to an increased risk of coronary heart disease (World Health Organization, 2006; Chokshi et al., 2013). Diabetes, hypertension, and obesity or being overweight all raise the risk of cardiovascular problems and other morbidities (Brown et al., 2000). Insulin resistance, on the other hand, has been linked to a two to five-fold increase in CVD mortality and is a mixture of multiple cardiometabolic risk factors such as obesity, poor glucose metabolism, hypertension, and dyslipidemia. It is also a risk factor for type 2 diabetes (Vepsäläinen, 2013). A recent study in Sudan found that low HDL is a common trait in two-thirds of diabetics, whereas high cholesterol and triglycerides were found in more than a quarter (Awadalla et al., 2018).

The evaluation of these lipid pathways and insulin resistance in Sudanese diabetes, in addition to the recurrent lipid profile study, may be an important cooperative step in the prediction of CVD since these atherogenic impacts may be mitigated by lifestyle changes. As a result, the purpose of this study was to evaluate the plasma levels of glucose, HbA1c, insulin, and lipid profile in Sudanese patients with T2DM.

Methods

This analytical case control study was approved by the Clinical Chemistry Department and the Research Committee of the College of Medical Laboratory Science at Sudan University of Science and Technology, ethical approval No (DSR – IEC – 02 – 1 – 2020), a written informed consent was taken from all participants in the study for data collection and publication. Between March 2020 and August 2021, the research was conducted in the Zenam Diabetic Center and Sudan Cardic Center at Khartoum Siate. The case group consisted of 165 Sudanese patients with diabetes type 2 and a cardiovascular condition who were diagnosed by physicians, whereas the control group consisted of 165 diabetic type 2 volunteers who did not have a cardiovascular problem (the sample size was calculated by using sample size Formula n = p = the proportion to the target population. q = 1-p z = the standard normal deviation, usually set at 1.96, which correspond to the level 95% confidence level, d = degree of accuracy desired, set at 0.05). Patients with renal, liver, or thyroid disease, as well as those who smoked, drank, or had hepatitis A, B, or C, were excluded from the study as all that conditions may affect the levels of tested parameters. The risk factor criteria were Obesity, high blood pressure, high LDL or low HDL cholesterol levels, family history CVD and age.

The case and control groups were age matched, ranging from 30 to 100 years old. The demographic data was acquired via a questionnaire after all participants gave their informed permission. The heights and weights of all the participants were measured. The BMI was computed by dividing the weight (kg) by the square of the height (m²) as proposed by Romero et al. (2012). Only one sample was obtained from each participant by using conventional vein puncture procedure, accordingly; 3 ml of blood was collected into a heparin container, spun at 3000 rpm for 3 minutes, and plasma was recovered and kept at -20°C until evaluated.

The concentrations of plasma glucose, HbA1c, and lipid profiles were determined using a Mindray BS-480 auto-chemistry analyzer, whereas insulin levels were determined using a Cobase 411 auto analyzer as proposed by Annani-Akollor et al. (2019). To ensure the accuracy and precision of the results, a level of control and calibrator given by the manufacturer in the reagent kit was evaluated using a sample run on a Mindary BS 480 auto analyzer.

Results

In this study, 330 people were included, with 165 diabetes type 2 patients with cardiovascular disease as the case group and 165 diabetic type 2 patients without cardiovascular disease as the control group. The findings revealed that 11.5% aged 30 to 49 years, 59.4% of patients aged 50 to 69 years, and 29.1% of patients aged 70 to 100 years were in the 30 to 49 age group, 59.4% of patients aged 50 to 69 years, and 29.1% of patients aged 70 to 100 years. Females accounted for 50.9% of the total, while men accounted for 49.1%. Duration of DM (33.3%) ranges from one month to seven years, (38.2%) from eight to fifteen years, and (28.5%) from sixteen to twenty-five years (More than 15 years). HTN lasted 24.2% (from 1 month to 7 years), 17.6% of the time (8-15 years), 16.4% of the time (more than 15 years), and 41.8% of the time there was no HTN. When comparing diabetics with cardiovascular disease to diabetics without cardiovascular disease, there was a substantial rise in BMI (29.4 5.3 kg/m², p value = 0.001) as in Table 1.

Discussion

The overall features of research participants revealed that patients aged 50-69 years old had the largest proportion of diabetics with cardiovascular disease. This finding was also obtained by Wu et al. (2015) who stated that the prevalence was greater among people aged 50 and older, as well as Teo and Dokainish (2017) reported that, the prevalence of CVD increased with age. Females had a larger prevalence of diabetic patients with cardiovascular complications (50.9%) than men (49.1 percent), this conclusion is similar to that of Teo and Dokainish (2017), which revealed a greater frequency of CVD in females.

The frequency of diabetic complications was much greater in individuals who had diabetes for a longer period of time. These findings are consistent with the findings of the Alam et al. (2021), which stated that long-term exposure to diabetes causes several diabetic problems. Furthermore, Rana et al. (2016) stated that patients with diabetes for more than ten years should be regarded to have a higher risk of cardiovascular disease.

This study found a significant difference in mean BMI, FBG, HBA1c, triglycerides, and insulin hormones between the two groups (P values 0.000, 0.001, 0.000, 0.015, and 0.000, respectively), as well as a significant decrease in mean HDL-C (P value 0.018), while there was no significant statistical difference in total cholesterol and LDL-C (P value > 0.05). Patients with T2DM at the LDL-C goal are nevertheless at a considerable risk of CVD events, according to a research by Timón et al. (2014) reported that, this residual risk is linked to a number of variables, including an increase in TG-rich proteins, a drop in HDL-C, and generalized obesity as measured by the body mass index (BMI), which is linked to a number of CVD risk factors and cardiovascular risk in T2DM patients.

This study found a significant increase in mean BMI, total cholesterol, HDL-C, and LDL-C in diabetic females when compared to diabetic males with a p value of 0.000. This finding is in line with another study that found: The prevalence of overweight in men and women varies depending on the country's level of development; higher BMI is more prevalent in men than women in high-income countries, whereas in low and middle-income countries, particularly in Arab countries, found a significant increase in mean BMI, total cholesterol, HDL-C, and LDL-C in women than men (Aderibigbe et al., 2018).

With a p value of > 0.05, there is no statistically significant difference in FBG, HBA1c, triglycerides, or insulin hormones. This finding is comparable to that of Moor et al. (2017) who found that mean total cholesterol and LDL-C levels were greater in women than in men, with a statistically significant difference, whereas HDL-C and triglycerides were not. This finding is also in line with that of Bertoluci and Rocha (2017) who found that women with diabetes had a greater chance of dying from cardiovascular causes than men.

Our research found a substantial positive link between HBA1c, insulin hormone levels, and diabetes patients' age (r = 0.115, p-value = 0.037, r = 0.122, p-value = 0.027). This result was verified by Huang et al. (2021) who found that there was a positive association between HBA1c level and age (Huang et al., 2021).

Although there was a significant negative association between LDL-C and age (r = -0.123, p = 0.026), there was no correlation between study parameters and BMI in this research. A significant positive correlation was also found between FBs, HBA1c level, and Duration of DM (r = 0.155, p-value = 0.005, r = 0.160, p-value = 0.004), as well as a significant negative correlation between total cholesterol, HDL-C, LDL-C, and Duration of DM (r = -0.152, p-value = 0.006, r = - 0.145, p-value = 0.040, r = -0.113, p = 0.040. This result is similar to another result from a study carried out by Priya and Begum (2020), which found a substantial positive link between HBA1c, total cholesterol, LDL-C, and duration of diabetes, but a significant negative correlation between HDL-C and duration of diabetes (Priya and Begum, 2020).

Data availability

Figshare. Salsabil. DOI: https://doi.org/10.6084/m9.figshare.19375664.v2 (AbdAlla et al., 2022)

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC BY 4.0 Public domain dedication).