Evaluation of serum triglyceride levels as a marker of long-term patient compliance in diabetes mellitus type

Introduction: Hypertrigliceridemia has been described as a very common co-morbidity in diabetes mellitus II patients, associated with insulin resistance and lipotoxicity. Although the exact pathophysiological association remains controversial, it is an established fat that increased fat circulation and localized accumulation, especially visceral, predisposes to faster disease progression and onset of macro- or micro-vascular complication. This clnical study aims to evaluate the presence of any correlation between long-term glycemic and lipidemic control in diabetic mellitus type II patients, based on the moderate use of statin treatment.

Materials and methods: The study population consists of 138 patients with diabetes mellitus type II, of which 85 males (mean age 61.1±4 years) and 53 females (mean age 61.5±5 years). All patients were tested bimonthly in the Diabetology Outpatient Department of our Clinic throughout 2010. For both sexes, mean years post diagnosis were 7.5±5. Patients were grouped according to the presence or absence of known hypertrigliceridemia and statin use and HbA1c% and serum lipids were measured every 3 months. Results were analyzed via ANOVA assuming a minimal statistical significance ratio of 95%.

Results: 86 patients had been diagnosed with increased triglycerides and were treated with monotherapy (statin), compared to 52 normolipidemic individuals. The proportion of dyslipidemic patients was similar in both sexes. The statin group members had a statistically significantly lower serum LDL (120 versus 137mg/dl) and higher serum triglycerides (203 versus 179mg/dl) compared to the control group, with comparable HDL (43 versus 46). Well regulated diabetic patients (HbA1c<7%) exhibited a better lipidemic profile compared to those still missing the goal (LDL 115 versus 128, triglycerides 148 versus 215, p<0.001). Interestingly, triglyceride levels appeared further improved as glycemic control intensified, with a mean level of 126 for individuals with HbA1c<6.5% compared to 194 for those between 6.5 and 7% (p<0.0001).

Conclusions: Hypertriglyceridemia in diabetes mellitus type II patients may not be adequately controlled via monotherapy, requiring more complicated treatment regimens. There are indications for a direct association of optimal triglyceride and glycemic control which may represent statin activity and/or improved dietary and exercise practices. Thus, hypertriglyceridemia is correlated with overall treatment compliance and should be used along with HbA1c for the chronic follow-up of diabetic patients.