A study of plasma of HDL level in diabetes mellitus

L Karpagavel^1*, N Ananthi²

¹Professor and HOD, Department Of Biochemistry, Madha Medical College and Research Institute, Thandalam, Chennai-600128, Tamil Nadu, INDIA.

²Professor and HOD, Department of Biochemistry, Saveetha Medical College and Hospital, Thandalam, Tamil Nadu, INDIA.

Email: karpag@yahoo.com

Abstract               Background: Numerous studies have shown that HDL cholesterol is strongly and inversely associated with the occurrence of cardiovascular events Aims and Objectives: To Study Plasma of HDL level in Diabetes mellitus. Methodology: This was a cross-sectional study carried out in the diabetic patients at tertiary health care center during six-month period i.e. January 2017 to July 2017 in the randomly selected 100 known diabetic patients, the diagnosis was confirmed by Oral Glucose tolerance test, in all the patients selected for study undergone Glycosylated HbA₁C, lipid profile.The statistical analysis done by One way ANOVA(Kruskal-Wallis statistic), calculated by SPSS 19 version software. Result: In our study we have seen that The majority of the patients were in the age group >60 i.e. 32%, 50-60 i.e. 27% followed by 40-50-26%, 30-40 i.e. 10%, 20-30 were 5%.The majority of the patients were Male i.e. 69% followed by Female i.e. 31%. The level of HDL in Normal (6.0%) patient were (Mean ±SD) 59 ± 2.34, in Prediabetic (6.0%-6.4%) was 42 ± 3.4 in Diabetic (>6.4) was 32 ± 4.5. This decreasing trend was statistically significant (p<0.0001, ANOVA-Kruskal-Wallis statistic=87.61) Conclusion: It can be concluded from our study that HDL level was inversely corelated with the Glycemic control (HbA₁C) in diabetic patients.

Key Word: Glycemic control (HbA₁C), HDL (High Density Lipoproteins), Type II diabetes.

INTRODUCTION

Numerous studies have shown that HDL cholesterol is strongly and inversely associated with the occurrence of cardiovascular events^3–7. HDL cholesterol participates in the efflux of cholesterol efflux from peripheral cells as well as in reverse cholesterol transport from these cells to the liver¹. According to studies, HDL has antioxidative and anti-inflammatory properties. It reduces LDL oxidation⁶, inhibits oxidized LDLinduced MCP-1 (monocyte chemoattractant protein 1) production and monocyte transmigration in a co-culture of human aortic endothelial cells and human aortic smooth muscle cells^7,8 and blunts inflammatory response of endothelial cells to TNF-α (tumour necrosis factor-1) and IL-1 (interleukin 1) stimuli⁹. Finally, it has been demonstrated to exert anti-thrombotic and anti-apoptotic effects¹⁰. It has been shown that its biological activity may change in various pathophysiological states. In the past it was believed that high level of HDL protects against the occurrence of cardiovascular disease, however new evidence suggest that in some pathological conditions cholesterol HDL may lose its protective properties and become pro-atherogenic. The results of studies confirm that high levels of HDL cholesterol may not be always beneficial. Systematic review and meta-regression analysis of randomized controlled trials testing lipid modifying interventions provided evidence that increasing circulating HDL-C did not reduce coronary heart disease morbidity or mortality¹¹. Also The Initiating Dialysis Early and Late (IDEAL) study, in which the efficacy of high to moderate dose statin regimen for the secondary prevention of cardiovascular disease was compared, and The European Prospective Investigation of Cancer, Norfolk (EPIC-Norfolk)¹² demonstrated that highly elevated HDL-C concentrations did not protect against cardiovascular disease. HDL becomes “dysfunctional” inter alia in type 2 diabetes, which may mean that also in pathological state relative composition of lipids and proteins in HDL, as well as enzymatic activities associated to HDL, such as paraoxonase 1 (PON1) and lipoprotein-associated phospholipase 11 (Lp-PLA2), are altered¹². It has been suggested that plasma HDL cholesterol is not homogeneous, it comprises different particles varying in size, density, apolipoprotein composition, and lipid content. The hypothesis of dysfunctional HDL-C in relation to its activity and reverse cholesterol transport, has been put forward in type 1 diabetes¹³. Generally increased HDL-C does not translate into lower cardiovascular risk in DMT1 patients, but rather an inverse association was observed. However, the exact mechanisms of such relationship remain not fully elucidated. It has beensuggested that different HDL subfractions relate to coronary artery disease (CAD) incidence in a different manner.

MATERIAL AND METHODS

This was a cross-sectional study carried out in the diabetic patients at tertiary health care center during six-month period i.e. January 2017 to July 2017 in the randomly selected 100 known diabetic patients, the diagnosis was confirmed by Oral Glucose tolerance test, in all the patients selected for study undergone Glycosylated HbA₁C, lipid profile. All details of the patients like age, sex etc. noted. The lipid profile of the study was analyzed as per the standard definition of dyslipidemia- Low HDL 190 mg/dl, high cholesterol >200 mg/dl, and high TG >200 mg/dl. The statistical analysis done by One way ANOVA(Kruskal-Wallis statistic ), calculated by SPSS 19 version software.

RESULT

Table 1: Distribution of the patients as per the age

The majority of the patients were in the age group >60 i.e. 32%, 50-60 i.e. 27% followed by 40-50-26%, 30-40 i.e. 10%, 20-30 were 5%.

Table 2: Distribution of the patients as per the sex

The majority of the patients were Male i.e. 69% followed by Female i.e. 31%

Table 3: Distribution of the patients as per the HDL

DISCUSSION

Recent studies have indicated that cholesterol HDL may directly alter glucose metabolism^13,14. Indeed, HDL cholesterol promotes pancreatic β-cell insulin secretion and modifies glucose uptake in skeletal muscle as shown in different experimental and human settings^27–30. Therefore, low levels of HDL cholesterol has been suggested to be associated with higher risk of type 2 diabetes in epidemiological studies^15,16. Moreover, plasma HDL level increase has been proposed as a therapeutic measure to reduce the risk of type 2 diabetes^17-19. However, the results of genetic studies evaluating the relationship between HDL cholesterol levels and glycaemic control and risk of type 2 diabetes are conflicting^20-22. In our study we have seen that The majority of the patients were in the age group >60 i.e. 32%, 50-60 i.e. 27% followed by 40-50-26%, 30-40 i.e. 10%, 20-30 were 5%. The majority of the patients were Male i.e. 69% followed by Female i.e. 31%. The level of HDL in Normal (6.0%) patient were (Mean ±SD) 59 ± 2.34, in Prediabetic (6.0%-6.4%) was 42 ± 3.4 in Diabetic (>6.4) was 32 ± 4.5. This decreasing trend was statistically significant (p<0.0001, ANOVA-Kruskal-Wallis statistic=87.61) Some studies demonstrated the relationship between HDL particles and lower risk of type 2 diabetes^27,28.

Hwang et al.³ found an inverse association between total cholesterol and HDL2 and future development of type 2 DM and this relationship was independent of well-established risk factors for type 2 diabetes. However, they failed to find any correlation between HDL3 cholesterol and future diabetes risk. Also Tabara et al.²⁹ suggested that high-density lipoprotein (HDL) may exert an anti-diabetes function. In their study HDL2 cholesterol levels were inversely associated with HOMA-IR (β = −0.169, p < 0.001) and type 2 diabetes (OR = 0.96, p = 0.001 Opposite relationship was observed in case of HDL3-C and HOMA-IR (β = 0.054, p < 0.001) and type 2 diabetes (OR = 1.04, p = 0.181). In turn, a longitudinal analysis demonstrated inverse relationship between HDL2-C and the exacerbation of insulin resistance (β = −0.163, p < 0.001) and the inverse risk of type 2 diabetes incidence (odds ratio = 0.98, p = 0.006)³⁰. It has been proposed that the deletion within ABCA1 may be associated with cholesterol accumulation within cell membrane of beta cells and further results in the hampering of the exocytosis of insulin from secretory granules, and inhibition of insulin secretion^31,32. Moreover, beneficial, apoptosis-inhibiting effects of HDLs on beta cells have also been demonstrated³³. Fryirs et al.³⁴ revealed that the incubation of Min6 cells and primary islets with HDLs isolated from human plasma or a constituent of discoidal reconstituted HDLs (rHDLs) or apolipoprotein (apo) A-I or apoA-II enhanced insulin secretion up to 5-fold in a calciumdependent as well as time and concentration dependent manner³⁵.

CONCLUSION

It can be concluded from our study that HDL level was inversely corelated with the Glycemic control (HbA₁C) in diabetic patients.

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