Diabetes & Metabolic Syndrome: Clinical Research & Reviews 13 (2019) 252e257 Contents lists available at ScienceDirect Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal homepage: www.elsevier.com/locate/dsx Original Article Prevalence of dyslipidemia among the diabetic patients in southern Bangladesh: A cross-sectional study * Hrishov Das, Sujan Banik Department of Pharmacy, Noakhali Science and Technology University, Noakhali, 3814, Bangladesh article info abstract Article history: Aim: Diabetic dyslipidemia is one of the major risk factors for cardiovascular disease which has a vast Received 6 August 2018 mortality rate throughout the world. Early detection and treatment of dyslipidemia can avoid risk for Accepted 7 September 2018 cardiovascular disorder in diabetic patients. This study was conducted to determine the prevalence of and pattern of dyslipidemia in diabetic patients. Keywords: Materials and methods: This cross sectional study was performed in several specialized diabetic hospital Bangladesh of Noakhali, a southern district of Bangladesh. All known cases of diabetes mellitus were evaluated for Cardiovascular diseases their lipid profile. A total number of 1008 patients were included in the study having 683 (67.8%) female Dyslipidemia Type 2 diabetes and 325 (32.2%) male subjects. Prevalence Results: The prevalence of dyslipidemia among the male subjects was 73% while among female subjects 71%. Among diabetic males the percentage of high serum Cholesterol, high serum TG (Triglyceride), low HDL (High density cholesterol) and high LDL (Low density cholesterol) was 35.69%, 44.31%, 50.15% and 72.92% respectively, whereas the female had the percentage at 35.29%, 40.85%, 49.49% and 70.57% respectively. Conclusion: Majority portion of the study subjects were dyslipidemic. The most prevalent pattern among both male and female was high level of LDL and low level of HDL. The prevalence of dyslipidemia in Bangladesh is significantly high, which indicates the urgency of lifestyle intervention strategies to pre- vent and manage this important health problem and risk factor. © 2018 Diabetes India. Published by Elsevier Ltd. All rights reserved. 1. Introduction developing countries, including Bangladesh [14,15]. The World Health Organization recently reported that dyslipidemia is signifi- Gradually increasing rapid socioeconomic development and cantly associated with more than half of global cases of ischemic related lifestyle changes has been causing an increase in the heart disease [16]. prevalence of dyslipidemia dramatically over the past decade in Dyslipidemia in the diabetic patients is a common phenomenon, Bangladesh and other South Asian countries [1e12] Studies from because insulin resistance or deficiency affects key enzymes and India and Bangladesh showed an increasing trend in the prevalence pathways in lipid metabolism and thus causing lipid abnormalities of dyslipidemia [11]. which are more prevalent in diabetes mellitus [17]. Particularly, the Dyslipidemia has been clearly determined as a major risk factor following processes are affected: apoprotein production, regulation for cardiovascular diseases that are the first cause of death in the of lipoprotein lipase, action of cholesteryl ester, transfer proteins developed and developing countries [13]. It has become one of the and hepatic and peripheral actions of insulin [18,19]. The presence leading cause of death in most developed countries as well as in of dyslipidemia (DLP) significantly increases cardiovascular risk among patient with diabetes [20]. Again, studies show that about 70e80% of diabetic patients will die of cardiovascular disease [21,22]. Abbreviations: BMI, Body Mass Index; TC, Total cholesterol; TG, Triglyceride; Though identifying and screening dyslipidemia in every nation HDL, High Density Lipoprotein; LDL, Low Density Lipoprotein; CVD, Cardiovascular to prevent occurrence and progression of cardiovascular diseases is Disease. * Corresponding author. Department of Pharmacy, Noakhali Science and Tech- very important, there are no proper and correct statistics on the nology University, Sonapur, Noakhali, 3814, Bangladesh. status of dyslipidemia and its determinants in majority of nations E-mail address: [email protected] (S. Banik). https://doi.org/10.1016/j.dsx.2018.09.006 1871-4021/© 2018 Diabetes India. Published by Elsevier Ltd. All rights reserved. H. Das, S. Banik / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 13 (2019) 252e257 253 [23,24]. Available data on the prevalence, types, and associated Table 1 factors of dyslipidemia in the general population of our country is Gender distribution and age of selected diabetic patients. relatively insufficient. The lack of enough knowledge to the status Gender No. of Patients Agea of dyslipidemia will lead to inappropriate programming and Female 683 49.77 ± 13.36 treatment approaches. This will lead to difficulties in scheduling Male 325 52.74 ± 12.81 suitable national managerial approaches for lipid lowering [25]. Total 1008 50.73 ± 13.37 The estimation of the prevalence of dyslipidemia will ensure proper a Units expressed as years (mean ± SD). planning of health care resources for both primary and secondary prevention of CVDs. Therefore, the objective of this study was to gather current data general characteristics of the subjects according to age and gender on dyslipidemia and to find out the relation between serum lipid including: age, weight, height, BMI (Body Mass Index), region, profile and blood sugar depending on the hypothesis that early systolic and diastolic blood pressure, total cholesterol (TC), TG detection and treatment of lipid abnormalities can minimize the (Triglyceride), HDL (High density Lipoprotein), LDL (Low density risk for atherogenic cardiovascular disorder and cerebrovascular Lipoprotein) and plasma glucose. According to the findings, the accident in diabetic patients. percentage of underweight, normal weight, overweight and obese subjects were 8.2%, 41.7%, 31.2% and 18.9%, respectively. The per- 2. Materials and methods centage of rural and urban subjects were 82.04% and 17.96%, respectively. Table 2 also shows the serum lipid profile of the 2.1. Study location and sample size subjects according to different age group, whereas Fig. 1 shows individual lipid profile for males and females. In male, total This was a multicenter, non-interventional, cross-sectional cholesterol, TG, HDL and LDL were 203.44 ± 55.3 mg/dl, observational study. Patients with diabetes mellitus who visited the 208.96 ± 129.63 mg/dl, 36.99 ± 10.06 mg/dl and 121.59 ± 48.83 mg/ two specialized Diabetic hospitals approved by Bangladesh Dia- dl, respectively, while those were in female 207.72 ± 90.46 mg/dl, betic Association, namely-i) M.A. Hashem Diabetic Hospital, 209.04 ± 140.83 mg/dl, 37.18 ± 9.37 mg/dl and 132.75 ± 75.11 mg/dl, Chowmuhani, Noakhali and ii) Alhaz Sirajul Hoque Diabetic Hos- respectively. pital, Maijdee, Noakhali, were included in the trial. Data from pa- Specific prevalence association of dyslipidemia in our study tients, who had agreed to informed consent to provide information, subjects depending on age groups are presented in Table 4. In male, were collected during their interaction with the doctor and sub- abnormal cholesterol level was 35.69%, age group of 41e50 years sequent testing of lipid profile. For this study, data were collected had the highest prevalence of disturbance cholesterol (42.85%). from 1008 diabetic patient attending the hospital randomly. 44.31% had greater than 150 mg/dl abnormal triglyceride level. The low HDL level was identified 50.15%, while 72.92% was high level of 2.2. Data collection LDL. The prevalence of both low HDL and high LDL level were the highest in male subjects. In female, percentage of patients with For data collection from respondents a questionnaire was pre- disturbed cholesterol level were 35.69%, percentage was highest pared in accordance with the objective set for the study. Before most in the subjects above the age of 70 years. In high level of preparing the questionnaire, a draft questionnaire was developed triglyceride out of 40.85%, 45.45% were >70 years and 44.79% were and then pre-tested in the study area. The questionnaire was then 51e60 years group. With low level of HDL was found 49.49% and modified and rearranged according to experience gathered in the 70.57% were identified as high level of LDL in female. Overall, the pre-testing. The final questionnaire then developed in logical highest prevalence of low HDL level and increased LDL level were sequence so that the respondents could answer chronologically. calculated 49.70% (n ¼ 501) and 71.33% (n ¼ 719) (Table 3). Alter- Question related to age, gender, religion, area, diagnosis included in natively, the abnormal cholesterol level was found in highest per- the questionnaire. After preparing questionnaire, the primary data centage in the underweight population (46.3%) and high LDL level collected from target sites during January 29, 2018 to April 17, 2018. was found in overweight population (74.8%). But the prevalence of both high TG and low HDL were highest in the obese population 2.3. Data processing and analysis 44.5% and 52.5% respectively (Fig. 2). In correlation studies, FBS showed significant positive correla- After collection of data, these were edited. All the collected data tion with total cholesterol (P < 0.01), TG (P < 0.01) and HDL were summarized and scrutinized carefully and then recorded. (P < 0.001) (Table 4). TC also showed significant