Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : CC11 - CC15 Full Version

Comparison of Lipid Profile in Prediabetic and Non Prediabetic Adult Off-springs of Type 2 Diabetics Patients: A Cross-sectional Study


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53428.16495
Sayali Eknathrao Raut, Smita Suresh Bute, Urjita Zingade, Atish Bhaskar Pagar

1. Associate Professor, Department of Physiology, Govt. Medical College, Miraj, Maharashtra, India. 2. Assistant Professor, Department of Physiology, Govt. Medical College, Miraj, Maharashtra, India. 3. Professor, Department of Physiology, RCSM GMC Kolhapur, Kolhapur, Maharashtra, India. 4. Professor, Department of Physiology, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India.

Correspondence Address :
Atish Bhaskar Pagar,
Prarambh, Bunglow No 3, Bakul Bag, Near Sanglikar Mala, Miraj-416410, Sangli, Maharashtra, India.
E-mail: abp123098@gmail.com

Abstract

Introduction: Lipid abnormality is an important modifiable risk factor associated with the type 2 diabetes mellitus and prediabetes. Dyslipidaemia occurring in diabetic patients, has important role in development of macrovascular atherosclerosis and increases the risk of cardiovascular disease. Furthermore, prediabetes has also been found to be associated with an increased risk for cardiovascular disease. Considering the prevalence and increased risk of cardiovascular disease in diabetes, it is becoming necessary to diagnose prediabetic individuals and assess their lipid profile and prevent them from developing overt diabetes and the further complications. Also, data available on lipid abnormalities in prediabetics is relatively less in the Indian population.

Aim: To compare lipid profile in prediabetic and non prediabetic adult off-springs of type 2 diabetics and to evaluate the association between lipid profile and prediabetes.

Materials and Methods: This cross-sectional study was conducted on 150 healthy young adult (> 18 years) off-springs of type 2 diabetic patients, willing to participate in the study in Government Medical College and Hospital, Miraj from January 2019 to December 2019. All the relevant information was collected by administering a structured case record form. Fasting blood samples were collected and fasting blood glucose level, lipid profile including Total cholesterol (TC), Triglycerides (TG), Low Density Lipoproteins (LDL), High Density Lipoproteins (HDL), Very Low-Density Lipoproteins (VLDL), were estimated and compared. Data collected was entered in the Microsoft excel (2010), expressed as frequency and mean. Chi-square test and Fisher’s exact test were applied to observe the association between different study parameters. A p-value <0.05 was considered statistically significant.

Results: Prevalence of prediabetes was 17.3% (fasting BLS 100 to 125 mg/dL) in age group of 26 to 30 years (26.67%). It was found that occurrence of prediabetes was more in male participants (25.37%) as compared to female participants (10.84%). Association between gender of the participants and occurrence of prediabetes was found to be statistically significant (p-value=0.019). The association between prediabetes and higher TC levels (mean-204.88±47.99 and 152.46±29.35 mg/dL), lower HDL levels (mean-57.65±4.59 and 66.18±6.02 mg/dL), higher LDL levels (mean-94.77±30.71 and 69.57±17.88 mg/dL), higher VLDL levels (mean-128.08±49.96 and 39.52±39.99 mg/dL) was found to be statistically significant (p-value<0.05) and the association between prediabetes and higher TG levels (mean-48.65±18.45 and 28.18±9.47 mg/dL) was not significant (p-value=0.056).

Conclusion: Total cholesterol, LDL, TG, VLDL were significantly raised, whereas HDL was significantly lower in prediabetic subjects as compared to non prediabetic healthy subjects. The association between prediabetes and higher TC levels, lower HDL levels, higher LDL levels, higher VLDL levels was found to be statistically significant (p-value<0.05) and the association between prediabetes and higher TG levels was not significant (p-value=0.056). So, prediabetic individuals, though asymptomatic have significant dyslipidaemia, that puts them at higher risk for developing cardiovascular disease.

Keywords

High density lipoproteins, Low density lipoproteins, Prediabetes, Total cholesterol, Triglycerides, Very low density lipoproteins

Diabetes mellitus is a metabolic disorder characterised by chronic hyperglycaemia with deranged fat, carbohydrate and protein metabolism resulting from inadequate secretion or action of insulin (1). It is a modern day epidemic. World Health Organisation (WHO) estimates that diabetes will become the seventh most common cause of mortality, worldwide, in the year 2030 (2).

India is the diabetes capital of the world because there are around 41 million Indians suffering from diabetes till date and every ?fth person in world, having diabetes, is an Indian (3),(4). Insulin resistance in children of type 2 diabetics is found to be 30% in siblings and 80% in identical twins (5). It is difficult to diagnose early, as it is mostly asymptomatic and usually presents with complications like nephropathy, cardiovascular disease, retinopathy, neuropathy, cerebrovascular disease and peripheral vascular disease (6). It can go undetected for 9-12 years and consequently, presents with complications (7). Recent studies have revealed that around half of the diabetics in the world are undiagnosed (3),(4).

American Diabetic Association has introduced a new category of blood glucose levels, preceding the onset of diabetes, known as prediabetes. Prediabetic individuals are at greater risk of development of diabetes (7). According to American Diabetic Association, person is labelled as prediabetic, when fasting plasma glucose level ranges from 100 to 125 mg/dL and/or when plasma glucose level 2 hours after an oral glucose tolerance test ranges from 140 to 199 mg/dL (8).

Though, prediabetes is an asymptomatic condition, it is always present before the onset of diabetes. Rise in blood sugar level is linear process so, prediabetes is not an entirely harmless condition (8).

In diabetic patients, dyslipidaemia plays a critical role in development of macrovascular atherosclerosis leading to increase in the risk of cardiovascular disease. Likewise, prediabetes is also associated with an increased risk for cardiovascular disease (9). As the prevalence of diabetes and so the risk of cardiovascular disease is increasing day by day, it has become important to diagnose prediabetic individuals, assess them for lipid profile and with early interventions prevent them from developing further complications.

The benefits of screening and treatment of lipid disorders in known type 2 diabetics with cardiovascular disorders are well documented. Still, there are no clear recommendations regarding screening for lipid disorders in asymptomatic prediabetic individuals. This is one of few studies, seeing the association of lipid profile with prediabetes in adult off-springs of known cases of type 2 diabetics, so as to help to form future prevention programs for diabetes and related complications. The aim of the present study was to compare lipid profile in prediabetic and non prediabetic adult off-springs of type 2 diabetics and to evaluate the association between lipid profile and prediabetes.

Material and Methods

This cross-sectional study was carried out in 150 apparently healthy young adult (>18 years) off-springs of either gender of type 2 diabetic patients in Outpatient Department of General Medicine, Government Medical College and Hospital, Miraj, Maharashtra, India, from January 2019 to December 2019. Ethical committee clearance was obtained from Institutional Ethical Committee (Ref No. GMCM/E-C/24/2018 Dated 26/10/2018).

Inclusion criteria: Apparently healthy young adult (>18 years) off-springs of known cases of type 2 diabetics of either gender willing to participate in the study were included in the study

Exclusion criteria: Subjects with type 1 and type 2 diabetes mellitus, Prediabetics and on hypoglycemic medicines, acute and chronic inflammatory disease, macular disorders, history of major illness or on treatment of renal disease, heart disease, hypoglycemia, dyslipidemia, thyroid disorders and tuberculosis and pregnancy were excluded from the study.

Sample size calculation: In a study by Pandeya U et al., (10), proportion of prediabetes among the study subjects was 32.1%. So according to the formula,

Sample size n= 4×P×Q / L2

P= Proportion=32.1%
Q= 100-P=67.9%
L= Margin of error=10% (at 95% Confidence Interval)
n= 4×32.1×67.9 / 10×10
= 87.18
n ˜ 87

Though calculated sample size was 87, 150 study subjects were enrolled during the study period of January 2019 to December 2019.

Method of Collection of Data

Apparently healthy young adult off-springs of known cases of type 2 diabetes mellitus patients, accompanying their parents, willing to participate were included in the study. They were informed about the study and written informed consent was obtained from each participant and they were requested to come in fasting state (minimum 8 hours) when they come for next follow-up of their parents and blood sample were taken at that time or blood sample was collected by the investigator from their residence, as per the convenience of the participant. All the information was collected by administering a structured case record form.

Following symptoms of hyperglycaemia were enquired in all subjects included in the study,

1. Excessive Thirst and Drinking
2. Frequent Urination
3. Recent Weight Loss
4. Fatigue
5. Recurrent Thrush or Skin Infections

The blood samples were collected with all aseptic precautions by the investigator by venepuncture in non dominant arm in sitting position after fasting of minimum 8 hours and following parameters were measured.

a. Fasting blood sugar level (fasting BSL): It was measured by enzymatic Glucose Oxidase Peroxidase method. Subjects were considered as prediabetic, if fasting BSL was between 100 to 125 mg% (11),(12).

b. Lipid profile: Total cholesterol (TC), Triglycerides (TG), Low Density Lipoproteins (LDL), High Density Lipoproteins (HDL), Very Low-Density Lipoproteins (VLDL), cholesterol/HDL were measured. Enzymatic method was used to measure total cholesterol and triglyceride levels. After centrifugation, the cholesterol in the HDL fraction, remaining in the supernatant was assayed with enzymatic Cholesterol Oxidase Peroxidase method. HDL-C was estimated after precipitation of chylomicrons. Whereas VLDL and LDL fractions of cholesterol were measured using phosphotungstic acid and magnesium chloride. All the estimations were done with Transasia biochemistry fully auto analyser- XL640.

Subjects, found to be diabetic or prediabetic were referred to Medicine OPD for further management.

Statistical Anaysis

Data collected was entered in the Microsoft excel (2010). Continuous and basic characteristics of study subjects were displayed as frequency (percentage) and mean with standard deviation (SD). The association between different study parameters were assessed using Chi-square test. Especially when more than 20% of cells had expected frequencies <5, Fisher’s exact test was used, because applying approximation method was inadequate. Unpaired t-test was used to compare lipid profile between prediabetics and healthy participants. A p-value was considered as significant, when <0.05.

Results

In present study, out of 150 participants, 83 (55.3%) were females and 67 (44.7%) were males. Females were slightly more than males. Male to female ratio was 0.81:1.

(Table/Fig 1) shows that out of 150 participants, mostly, 65 (43.3%) were from age group 21 to 25 years followed by 34 (22.7%) were from age group ≤20 years and 31 (20.7%) from age group 31 to 35 years. Only 15 (10%) and 5 (3.3%) participants were from age group 26 to 30 years and >35 years respectively. Mean age of the participants was 25.01±5.55 years ranging from 18 to 36 years.

(Table/Fig 2) shows classification of participants on the basis of fasting blood sugar level. 26 (17.3%) participants were found to be prediabetic and remaining 124 (82.7%) participants had normal fasting blood sugar levels.

(Table/Fig 3) shows that occurrence of prediabetes was maximum in age group 26 to 30 years (26.67%) followed by 17.64% in age group ≤20 years but association between age of the participants and occurrence of prediabetes was not found to be statistically significant (p-value=0.749). Mean age of the prediabetics and healthy participants were 25.62±1.70 and 25.65±1.75 years, respectively and the difference was not statistically significant (p-value=0.845).

(Table/Fig 4) shows that occurrence of prediabetes was more in male participants (n=17; 25.37%) as compared to female participants (n-9; 10.84%). Association between gender of the participants and occurrence of prediabetes was found to be statistically significant (p-value=0.019).

(Table/Fig 5) shows that out of 17 participants with TC >200 mg/dL, 10 (58.82%) participants were found to have prediabetes. Whereas out of 133 participants with TC ≤200 mg/dL, only 16 (12.03%) participants were found to have prediabetes. The association between prediabetes and lower HDL levels (mean-57.65±4.59 and 66.18±6.02 mg/dL), was not found to be significant (p-value -0.582).

(Table/Fig 6) shows that out of 28 participants with HDL ≤40 mg/dL, 11 (39.29%) participants were found to have prediabetes. Whereas out of 122 participants with HDL >40 mg/dL, only 15 (12.30%) participants were found to have prediabetes. The association between prediabetes and lower HDL levels was found to be statistically significant (p -value=0.001).

Table/Fig-7 shows that out of 05 participants with LDL >130 mg/dL, all 5 participants were found to have prediabetes. Whereas out of 145 participants with LDL ≤130 mg/dL, only 21 (14.48%) participants were found to have prediabetes. The association between prediabetes and higher LDL levels was found to be statistically significant (p-value <0.05).

(Table/Fig 8) shows that out of 69 participants with VLDL >30 mg/dL, 26 (37.68%) participants were found to have prediabetes. Whereas out of 81 participants with VLDL ≤30 mg/dL, none of the participants was found to have prediabetes. The association between prediabetes and higher VLDL levels was found to be statistically significant (p-value <0.05).

(Table/Fig 9) shows that out of 14 participants with TG >150 mg/dL, 5 (35.71%) participants were found to have prediabetes. Whereas out of 136 participants with TG ≤150 mg/dL, 21 (15.44%) participants were found to have prediabetes. The association between prediabetes and higher TG levels was not significant (p-value=0.056).

(Table/Fig 10) shows that mean TC (204.88±47.99 and 152.46±29.35 mg/dL), mean LDL (94.77±30.71 and 69.57±17.88 mg/dL), mean VLDL (128.08±49.96 and 39.52±39.99 mg/dL) and mean TGs (48.65±18.45 and 28.18±9.47 mg/dL) were significantly high in pre-diabetic participants compared with healthy participants. Whereas difference between mean HDL levels (57.65±4.59 and 66.18±6.02 mg/dL) was not found to be significant.

Discussion

The present study is among the few studies of Indian population assessing the association between serum lipid profile and prediabetes in adult off-springs of known cases of type 2 diabetics. In the present study, mean age of the participants was 25.01±5.55 years ranging from 18 to 36 years. Whereas, in a study conducted by Pandey U et al, the mean age of male participants was 18.5±1.5 years and the mean age of females was 17.9±1.8 years (10). Similarly, in a study conducted on adults by Woldegebriel AG et al, the mean age of the study subjects was 39.3 years (13). The majority of the respondents (71.75%) were in the age group of 24-44 years. Also, in the study by Bisht I et al., mean age of the participants was 45.89±9.35 years (14).

It was found that occurrence of prediabetes was maximum in age group 26 to 30 years (26.67%) followed by 17.64% in age group ≤20 years but association between age of the participants and occurrence of prediabetes was not found to be statistically significant (p-value=0.749).

Considering the gender- wise distribution of the participants, out of 150 participants, 83 (55.3%) were females and 67 (44.7%) were males. In the study conducted by Ramya HS et al, with 389 adolescent participants, 45% were girls and 55% were boys (15). Bisht I et al in a study with 80 apparently healthy subjects, had more male participants 45 (56.25%) than female participants 35 (43.75%) (14). Also, in a study conducted by Pandey U et al, out of 526 subjects, 277 (52.66%) were boys and 249 (47.34%) were girls (10).

It was found that occurrence of prediabetes was more in male participants (25.37%) as compared to female participants (10.84%). Association between gender of the participants and occurrence of prediabetes was found to be statistically significant (p-value=0.019). Comparable findings were seen in a study by Bisht I et al, with more prevalence of prediabetes in males, but occurrence of prediabetes was not significant (p-value=0.896) (14). This was different from the results of the Spurr study which showed no significant difference between men and women diagnosed with prediabetes (16).

In the present study, 26 (17.3%) participants were found to be pre-diabetic (fasting BLS 100 to 125 mg/dL). Whereas in the study conducted by Pandey U et al, prevalence of prediabetes among the study subjects was found to be 32.1%(10). The difference between findings of these two studies may be due to the different criteria used for estimating glucose intolerance as present study measured fasting plasma glucose levels and the study by Pandey U et al measured the plasma glucose levels two hours following Oral Glucose Tolerance Test (OGTT). Indian Council of Medical Research (ICMR)-INDIAB study, found the prevalence of diabetes to be 10.4% in Tamil Nadu, 8.4% in Maharashtra, 5.3% in Jharkhand and 13.6% in Chandigarh and the prevalence of prediabetes to be 8.3%, 12.8%, 8.1% and 14.6%, respectively (17). The Delhi Urban Diabetes Survey (DUDS) done by Madhu et al, showed a prevalence of prediabetes as 21% using WHO criteria and 39.5% using American Diabetic Association (ADA) criteria (18).

The association between prediabetes and higher TC levels, lower HDL levels, higher LDL levels, higher VLDL levels was found to be statistically significant (p-value <0.05) and the association between prediabetes and higher TG levels was not significant (p- value =0.056). These findings are consistent with the study by Kansal S. et al, which showed that, prediabetes was significantly associated with higher TC levels, lower HDL levels, higher LDL levels, higher VLDL levels (p-value <0.05) (19).

In the present study, mean TC (204.88±47.99 and 152.46±29.35 mg/dL) was significantly high in prediabetic participants compared with healthy participants. Findings of present study are in accordance with a study by Bisht I et al, which showed that, mean Cholesterol level was significantly higher among prediabetics when compared with healthy participants (199.65±51.96 and 176.75±39.17 mg/dL respectively) (14). Same observations were seen in a study by Kansal S. et al, where the mean value of total cholesterol for cases (184.75±46.02 mg/dL) was significantly more than controls (170.99±38.27 mg/dL) (19).

Mean LDL (94.77±30.71 of prediabetics and 69.57±17.88 mg/dL of non prediabetics), was found to be significantly high in prediabetic participants compared with healthy participants. The findings are in support with a study by Kansal S. et al, where te mean LDL value for case (120.39±38.34 mg/dL) was significantly more than controls (99.84±29.57 mg/dL) (19). Also, mean VLDL was significantly high in prediabetic participants (128.08±49.96) compared with healthy participants (39.52±39.99 mg/dL) in the present study. The findings were in agreement with the study by Kansal S. et al, with mean value of VLDL for case (29.07±20.08 mg/dL) significantly more than controls (22.27±of 14.32 mg/dL) (19). But, the difference between mean HDL levels between prediabetics (57.65±4.59) and healthy individuals (66.18±6.02 mg/dL) was found to be not significant in the present study. Although, the association between prediabetes and lower HDL levels, was found to be statistically significant (p value <0.05)

In the present study, mean TG level was significantly higher in prediabetic participants (48.65±18.45) compared with healthy participants (28.18±9.47 mg/dL). Similar findings were reported in a study by Kansal S. et al, with the value of triglyceride for cases (139.5±47.24 mg/dL) significantly higher than controls (106.81±61.97 mg/dL) (19). Rahbar S et al., also reported that prediabetics are having high triglyceride (TG) levels (20). Also, Barzi F et al., Gaziano JM et al., and Boizel R et al found that TG levels were significantly higher in participants with impaired fasting glucose than participants with normal fasting glucose (21),(22),(23).

In clinical practice, lipid abnormalities are monitored using parameters like Total cholesterol, Triglycerides, High Density Lipoproteins, Low Density Lipoproteins, Very Low-Density Lipoproteins. Though cardiovascular complications related to lipid disorders are significant contributors to the costs of diabetes care, evidence-based recommendation for screening of lipid disorders is not available (24). Many studies showed that higher rates of diabetes-related microvascular and macrovascular complications are a result of less diagnosis and delayed treatment of lipid disorders (25),(26). Treatment with lipid lowering drugs benefits T2DM patients more than non diabetic patients as shown by a systematic review and meta-analysis of randomized controlled trials (RCTs) (27). Therefore, it is recommended that early screening and correction of lipid disorders should be included in management of prediabetes and prevention of T2DM complications.

Limitation(s)

The nature of the study design (cross-sectional) was such that recording of parameters was done only on single occasion. The reported findings were of prediabetic patients; so, the results may not be generalized. Other information, like lifestyle variables were not considered.

Conclusion

In the present study, prevalence of prediabetes was 17.3%. Prevalence of prediabetes was more in age group 26 to 30 years and in male participants. Total cholesterol, LDL, TG, VLDL, were significantly raised whereas HDL was significantly lower in prediabetic individuals as compared to non prediabetic healthy subjects. Thus, dyslipidaemia puts prediabetic diagnosis and timely treatment can help to prevent/decrease serious complications of diabetes. So, young adults with family history of diabetes mellitus needs to be identified for regular screening of blood sugar and lipid profile as the onset of glucose intolerance can occur in the young adults. In future, the same study can be conducted in prospective way with a large cohort of prediabetic patients by grouping subjects depending on changes in lipid profiles over a length of considerable follow-up period instead of considering them as a single index.

Acknowledgement

Authors acknowledge the subjects for their participation in the study.

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DOI and Others

DOI: 10.7860/JCDR/2022/53428.16495

Date of Submission: Nov 24, 2021
Date of Peer Review: Jan 22, 2022
Date of Acceptance: Mar 29, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

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