Skip to main content

Advertisement

Log in

Clinical significance of HbA1c as a marker of circulating lipids in male and female type 2 diabetic patients

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Diabetic patients with accompanied (but often unnoticed) dyslipidemia are soft targets of cardiovascular deaths. An early intervention to normalize circulating lipids has been shown to reduce cardiovascular complications and mortality. Glycated hemoglobin (HbA1c) is a routinely used marker for long-term glycemic control. This investigation is an attempt to evaluate the diagnostic value of HbA1c in predicting diabetic dyslipidemia. Venous blood samples were collected from 2,220 type 2 diabetic patients (ages, 35–91 years; male/female ratio, 1.07). The sera were analyzed for HbA1c, fasting blood glucose (FBG), total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL). The levels of HbA1c did not differ significantly between males (8.33 ± 0.06%) and females (8.47 ± 0.07%), whereas female patients had significantly higher FBG (10.01 ± 0.13 mmol/l) than males (9.31 ± 0.11 mmol/l). HbA1c showed direct and significant correlations with cholesterol, triglycerides and LDL and inverse correlation with HDL. Female diabetic patients had significantly higher levels of serum cholesterol (5.42 ± 0.03 vs. 5.18 ± 0.03 mmol/l) and HDL (1.32 ± 0.01 vs. 1.12 ± 0.01 mmol/l) as compared to males. There was no significant difference in triglycerides and LDL between the two genders. Older patients (>70 years) had significantly lower FBG, cholesterol, triglycerides and LDL. There was a linear and significant increase in triglycerides in the patients of both genders with impaired glycemic control. Both male and female patients with worse glycemic control (HbA1c > 9%) had significantly high cholesterol and LDL levels. Serum HDL showed a significant and inverse relationship with uncontrolled hyperglycemia in females but not in males. These findings clearly suggest that HbA1c can provide valuable supplementary information about the extent of circulating lipids besides its primary role in monitoring long-term glycemic control. Further studies are warranted to reinforce the potential of HbA1c as a biomarker for screening of high-risk diabetic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Berry C, Tardif JC, Bourassa MG (2007) Coronary heart disease in patients with diabetes: part I: recent advances in prevention and noninvasive management. J Am Coll Cardiol 49:631–642

    Article  PubMed  CAS  Google Scholar 

  2. Sultan A, Thuan JF, Avignon A (2006) Primary prevention of cardiovascular events and type 2 diabetes: should we prioritize our interventions? Diabetes Metab 32:559–567

    Article  PubMed  CAS  Google Scholar 

  3. Rader DJ (2007) Effect of insulin resistance, dyslipidemia, and intra-abdominal adiposity on the development of cardiovascular disease and diabetes mellitus. Am J Med 120:S12–S18

    Article  PubMed  CAS  Google Scholar 

  4. Giansanti R, Rabini RA, Romagnoli F, Fumelli D, Sorichetti P, Boemi M, Fumelli P (1999) Coronary heart disease, type 2 diabetes mellitus and cardiovascular disease risk factors: a study on a middle-aged and elderly population. Arch Genontol Geriatr 29:175–182

    Article  CAS  Google Scholar 

  5. Jones PH (2006) Clinical significance of recent lipid trials on reducing risk in patients with type 2 diabetes mellitus. Am J Cardiol 99:133–140

    Article  CAS  Google Scholar 

  6. Smith SC Jr (2007) Multiple risk factors for cardiovascular disease and diabetes mellitus. Am J Med 120:S3–S11

    Article  PubMed  Google Scholar 

  7. Nasri H, Yazdani M (2006) The relationship between serum LDL-cholesterol, HDL-cholesterol and systolic blood pressure in patients with type 2 diabetes. Kardiol Pol 64:1364–1368

    PubMed  Google Scholar 

  8. Gotto AM Jr (2007) Cardiologist’s role in improving glucose control and global cardiovascular risk in patients with type 2 diabetes mellitus. Am J Cardiol 99:3–5

    Article  Google Scholar 

  9. Miljanovic B, Glynn RJ, Nathan DM, Manson JE, Schaumberg DA (2004) A prospective study of serum lipids and risk of diabetic macular edema in type 1 diabetes. Diabetes 53:2883–2892

    Article  PubMed  CAS  Google Scholar 

  10. Davey RA, Tabbutt NC, Favaloro JM, O’Neal DN, Rae D, Zajac JD, Best JD (2006) Severe combined hyperlipidemia and retinal lipid infiltration in a patient with type 2 diabetes mellitus. Lipids Health Dis 5:29–33

    Article  PubMed  CAS  Google Scholar 

  11. Rohlfing CL, Wiedmeyer HM, Little RR, England JD, Tennill A, Goldstein DE (2002) Defining the relationship between plasma glucose and HbA1c: analysis of glucose profiles and HbA1c in the Diabetes Control and Complications trial. Diabetes Care 25:275–278

    Article  PubMed  CAS  Google Scholar 

  12. Selvin E, Coresh J, Golden SH, Brancati FL, Folsom AR, Steffes MW (2005) Glycemic control and coronary heart disease risk in persons with and without diabetes: the atherosclerosis risk in communities study. Arch Intern Med 165:1910–1916

    Article  PubMed  Google Scholar 

  13. Selvin E, Coresh J, Shahar E, Zhang L, Steffes M, Sharrett AR (2005) Glycemia (haemoglobin A1c) and incident of ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) study. Lancet Neurol 4:821–826

    Article  PubMed  CAS  Google Scholar 

  14. Ravipati G, Aronow WS, Ahn C, Sujata K, Saulle LN, Weiss MB (2006) Association of hemoglobin A1c level with the severity of coronary artery disease in patients with diabetes mellitus. Am J Cardiol 97:968–969

    Article  PubMed  CAS  Google Scholar 

  15. Selvin E, Wattanakit K, Steffens MW, Coresh J, Sharrett AR (2006) HbA1c and peripheral arterial disease in diabetes: the Atherosclerosis Risk in Communities study. Diabetes Care 29:877–882

    Article  PubMed  Google Scholar 

  16. Kawasumi M, Tanaka Y, Uchino H, Shimizu T, Tamura Y, Sato F, Mita T, Watada H, Sakai K, Hirose T, Kawamori R (2006) Strict glycemic control ameliorates the increase of carotid IMT in patients with type 2 diabetes. Endocr J 53:45–50

    Article  PubMed  Google Scholar 

  17. Woodward A, Wallymahmed M, Wilding J, Gill G (2005) Improved glycemic control: an unintended benefit of a nurse-led cardiovascular risk reduction clinic. Diabet Med 22:1272–1274

    Article  PubMed  CAS  Google Scholar 

  18. Nakamura K, Yamagishi SI, Adachi H, Kurita-Nakamura Y, Matsui T, Yoshida T, Sato A, Imaizumi T (2007) Elevation of soluble form of receptor for advanced glycation end products (sRAGE) in diabetic subjects with coronary artery disease. Diabetes Metab Res Rev 23(5):368–371

    Article  PubMed  CAS  Google Scholar 

  19. Rosediani M, Azidah AK, Mafauzy M (2006) Correlation between fasting plasma glucose, post prandial glucose and glycated haemoglobin and fructosamine. Med J Malaysia 61:67–71

    PubMed  CAS  Google Scholar 

  20. Akbar DH, Ahmed MM, Algamdi AA (2003) Cardiovascular risk factor in Saudi Arabian and non-Saudi Arabian diabetic patients in Saudi Arabia. East Medit Health J 9:884–892

    CAS  Google Scholar 

  21. Ciardullo AV, Azzolini L, Bevini M, Cadioli T, Malavasi P, Morellini A et al (2004) Non-HDL cholesterol predicts coronary heart disease in primary prevention: findings from an Italian 40–69-year-old cohort in general practice. Monaldi Arch Chest Dis 62:69–72

    PubMed  Google Scholar 

  22. Ito C, Maeda R, Ishida S, Sasaki H, Harada H (2000) Correlation among fasting plasma glucose, two-hour plasma glucose levels in OGTT and HbA1c. Diabetes Res Clin Pract 50:225–230

    Article  PubMed  CAS  Google Scholar 

  23. Ko GT, Chan JC, Woo J, Lau E, Yeung VT, Chow CC, Li JK, So WY, Chan WB, Cockram CS (1998) Glycated hemoglobin and cardiovascular risk factors in Chinese subjects with normal glucose tolerance. Diabet Med 15:573–578

    Article  PubMed  CAS  Google Scholar 

  24. Ladeia AM, Adan L, Couto-Silva AC, Hiltner A, Guimaraes AC (2006) Lipid profile correlates with glycemic control in young patients with type 1 diabetes mellitus. Prev Cardiol 9:82–88

    Article  PubMed  CAS  Google Scholar 

  25. Faulkner MS, Chao WH, Kamth SK, Quinn L, Fritschi C, Maggiore JA, Williams RH, Reynolds RD (2006) Total homocysteine, diet and lipid profiles in type 1 and type 2 diabetic and non-diabetic adolescents. J Cardiovasc Nurs 21:47–55

    Article  PubMed  Google Scholar 

  26. Chan WB, Tong PC, Chow CC, So WY, Ng MC, Ma RC, Osaki R, Cockram CS, Chan JC (2005) Triglyceride predicts cardiovascular mortality and its relationship with glycemia and obesity in Chinese type 2 diabetic patients. Diabetes Metab Res Rev 21:183–188

    Article  PubMed  CAS  Google Scholar 

  27. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M (1998) Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 339:229–234

    Article  PubMed  CAS  Google Scholar 

  28. Gu K, Cowie CC, Harris MI (1999) Diabetes and decline in heart disease mortality in US adults. JAMA 281:1291–1297

    Article  PubMed  CAS  Google Scholar 

  29. Walden C, Knopp R, Wahl P, Beach K, Strandness E (1984) Sex differences in the effect of diabetes mellitus on lipoprotein triglyceride and cholesterol concentrations. N Engl J Med 311:953–959

    Article  PubMed  CAS  Google Scholar 

  30. Howard B, Cowan L, Go O, Welty T, Robbins D, Lee E (1998) Adverse effects of diabetes on multiple cardiovascular disease risk factors in women: the Strong Heart Study. Diabetes Care 21:1258–1265

    Article  PubMed  CAS  Google Scholar 

  31. Steinberg HO, Paradisi G, Cronin J, Crowde K, Hempfling A, Hook G, Baron AD (2000) Type II diabetes abrogates sex differences in endothelial function in pre-menopausal women. Circulation 101:2040–2046

    PubMed  CAS  Google Scholar 

  32. Wexler DJ, Grant RW, Meigs JB, Nathan DM, Cagliero E (2005) Sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes. Diabetes Care 28:514–520

    Article  PubMed  Google Scholar 

  33. The Diabetes Prevention Program Research Group (2005) Lipid, lipoproteins, C-reactive protein, and hemostatic factors at baseline in the diabetes prevention program. Diabetes Care 28:2472–2479

    Article  Google Scholar 

  34. Mohamad M, Arshad F, Noor MIM, Ali R (1997) Prevalence of dyslipidemia in non-insulin-dependent diabetic patients attending armed forces clinics in Kuala Lumpur. Asia Pacific J Clin Nutr 6:203–206

    Google Scholar 

  35. Esteghamati A, Abbasi M, Nakhjavani M, Yousefizadeh A, Basa AP, Afshar H (2006) Prevalence of diabetes and other cardiovascular risk factors in an Iranian population with acute coronary syndrome. Cardiovasc Diabetol 5:15

    Article  PubMed  Google Scholar 

  36. Sibley SD, Thomas W, de Boer I, Brunzell JD, Steffes MW (2006) Gender and elevated albumin excretion in the Diabetes Control and Complications trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort: role of central obesity. Am J Kidney Dis 47:223–232

    Article  PubMed  CAS  Google Scholar 

  37. Doruk H, Mas MR, Ateskan U, Isik AT, Saglam M, Kutlu M (2005) The relationship between age ad carotid artery intima-media thickness, hemoglobin A1c in nondiabetic, healthy geriatric population. Arch Gerontol Geriatr 41:113–119

    Article  PubMed  CAS  Google Scholar 

  38. Kalofoutis C, Piperi C, Zisaki A, Singh J, Harris F, Phoenix D, Alaveras A, Kalofoutis A (2006) Differences in expression of cardiovascular risk factors among type 2 diabetes mellitus patients of different age. Ann N Y Acad Sci 1084:166–177

    Article  PubMed  CAS  Google Scholar 

  39. Petitti DB, Imperatore G, Palla SL, Daniels SR, Dolan LM, Kershnar AK et al (2007) Serum lipids and glucose control: the SEARCH for Diabetes in Youth study. Arch Pediatr Adolesc Med 161:159–165

    Article  PubMed  Google Scholar 

  40. El-Hazmi MA, Al-Swailem AR, Warsy AS, Al-Meshari AA, Sulaimani R, Al-Swailem AM, Magbool GM (1999) Lipids and related parameters in Saudi type II diabetes mellitus patients. Ann Saudi Med 19:304–307

    PubMed  CAS  Google Scholar 

  41. Daghash MH, Bener A, Zirie M, Dabdoub W, Al-Hamaq AO, Al-Arabi ZA (2007) Lipoprotein profile in Arabian type 2 diabetic patients: relationship to coronary artery diseases. Int J Cardiol (in press)

  42. Lin SD, Tu ST, Hsu SR, Lin KC, Sheu WH (2006) Characteristics predicting dyslipidemia in drug-naive type 2 diabetes patients. J Chin Med Assoc 69:404–408

    Article  PubMed  CAS  Google Scholar 

  43. Smellie WS (2006) Hypertriglyceridaemia in diabetes. BMJ 333:1257–1260

    Article  PubMed  Google Scholar 

  44. DeFaria Yeh D, Freeman MW, Meigs JB, Grant RW (2007) Risk factors for coronary artery disease in patients with elevated high-density lipoprotein cholesterol. Am J Cardiol 99:1–4

    Article  PubMed  CAS  Google Scholar 

  45. Sun YH, Yang YJ, Pei WD, Wu YJ, Gao RL (2006) Patients with low high-density lipoprotein-cholesterol or smoking are more likely to develop myocardial infarction among subjects with a visible lesion or stenosis in coronary artery. Circ J 70:1602–1605

    Article  PubMed  Google Scholar 

  46. Bellomo A, Mancinella M, Troisi G, Ettorre E, Marigliano V (2007) Diabetes and metabolic syndrome (MS). Arch Gerontol Geriatr 44:61–67

    Article  PubMed  CAS  Google Scholar 

  47. Avogaro A, Giorda C, Maggini M, Mannucci E, Raschetti R, Lombardo F et al (2007) Incidence of coronary heart disease in type 2 diabetic men and women: impact of microvascular complications, treatment and geographic location. Diabetes Care 30(5):1241–1247

    Article  PubMed  Google Scholar 

  48. Eshaghian S, Horwich TB, Fonarow GC (2006) An unexpected inverse relationship between HbA1c levels and mortality in patients with diabetes and advanced systolic heart failure. Am Heart J 151:91

    Article  PubMed  CAS  Google Scholar 

  49. Schulze MB, Shai I, Manson JE, Li T, Rifai N, Jiang R, Hu FB (2004) Joint role of non-HDL cholesterol and glycated haemoglobin in predcting future coronary heart disease events among women with type 2 diabetes. Diabetologia 47:2129–2136

    Article  PubMed  CAS  Google Scholar 

  50. Onat A, Sari I, Yazici M, Can G, Hergenc G, Avci GS (2006) Plasma triglycerides, an independent predictor of cardiovascular disease in men: a prospective study based on a population with prevalent metabolic syndrome. Int J Cardiol 108:89–95

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The author is thankful to Dr. Samia H. Sobki and Mr. Shaukat A. Khan of Division of Clinical Biochemistry, Department of Pathology, Armed Forces Hospital, Riyadh, Saudi Arabia for their support and cooperation during the course of this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Haseeb Ahmad Khan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ahmad Khan, H. Clinical significance of HbA1c as a marker of circulating lipids in male and female type 2 diabetic patients. Acta Diabetol 44, 193–200 (2007). https://doi.org/10.1007/s00592-007-0003-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-007-0003-x

Keywords

Navigation