Analysis Of Association Between Serum Lipid Levels And Diabetes Among Adults

Objective:Recently,the prevalence rate of diabetes mellitus(DM)and pre-diabetes is increasing all over the world.DM is always associated with dyslipidemia and the condition is aggravation with DM.According to the available research,there are some differences in serum lipid between DM patients and normal people,but the indicators are simple and the studies among pre-diabetes are rare.We divided the people into three groups which were normal blood glucose,pre-diabetes and DM according to international diagnostic criteria for diabetes.The main indicators were TC,TG,HDL-C,LDL-C,Apo B and TG/HDL-C.We mastered the situation of people’s serum lipid and compare the differences among patients in different groups and analyzed the relationship between six serum lipid factors and different level of DM.Meanwhile,we focused on the risk of DM or pre-diabetes in people with different serum lipid level.We aimed to give specific advice to people with different serum lipid level to prevent DM and give more evidence to diagnose DM and pre-diabetes.Methods:The study based on NHANES database(2007-2016).We included all people more than 20 years old.We excluded the following people:(1)people whose data lost main indicators,(2)people take pills to control serum lipid or blood glucose,(3)pregnant women.7791 people were finally involved in the study.The main factors were demographic information(gender,age,income,etc.),bio-sample information(blood glucose,lipid index and TG/HDL-C,etc.),behavior and other factors(dietary habits,physical exercise,smoking,drinking,family history,etc.).IBM＿SPSS 24.0software and R 4.0.3-studio were applied in the study.Firstly,the samples were weighted.Using mean and standard deviation or median and inter-quartile range to describe.In order to analyze the differences between groups of continuous variables t test,analysis of variance and Wilcoxon rank sum test were employed.The differences between groups of categorical variables were analyzed by chi-square test.Employing logistic regression to understand the association between dyslipidemia and DM.The credibility level was stipulated as α=0.05.Results:1.Among 7791 subjects,1638(19.6%)were pre-diabetes,and 576(5.6%)had DM.The level of TG,LDL-C,Apo B,TG / HDL-C and fasting glucose in male were higher than those in female.The levels of TC,HDL-C and 2h PG in female were higher than those in male.In addition,there was no statistical difference in TC and LDL-C between pre-diabetes and DM,the differences among other groups were significant.2.Gender,age,race,marital status,poverty status,BMI group,smoking and drinking have significant differences in the distribution of blood glucose;except drinking,different characteristics and behavior groups have significant differences in the distribution of TC;except drinking,different characteristics and behavior groups have significant differences in the distribution of TG;gender,age,race have significant differences in the distribution of blood glucose.There were significant differences in the distribution of HDL-C among race and marital status,poverty status,BMI,smoking and drinking;except for race,smoking and drinking,there were significant differences in the distribution of LDL-C among groups with different characteristics and behaviors;except drinking and poverty status,there were significant differences in the distribution of Apo B among groups with different characteristics and behaviors The differences of TG / HDL-C levels were statistically significant in different gender,age,race,marital status,poverty,BMI,smoking and drinking groups.3.Spearman correlation analysis showed that fasting blood glucose was associated with TC(rs=0.157,95%CI: 0.133～0.178,P<0.001),TG(rs=0.275,95%CI: 0.254～0.295,P<0.001),LDL-C(rs=0.178,95%CI: 0.157～0.199,P<0.001),Apo B(rs=0.260,95%CI: 0.237～0.281,P<0.001)and TG/HDL-C(rs=0.289,95%CI:0.268～0.310,P<0.001).There was a positive correlation between fasting blood glucose and HDL-C(rs=-0.219,95%CI:-0.241～-0.196,P<0.001),and a negative correlation between fasting blood glucose and HDL-C(rs=-0.219,95%CI:-0.241～-0.196,P<0.001).After 2h PG,blood glucose and TC(rs=0.171,95%CI:0.151～0.192,P<0.001),TG(rs=0.266,95%CI: 0.246～0.287,P<0.001),LDL-C(rs=0.151,95%CI: 0.131～0.174,P<0.001).There was a positive correlation between Apo B(rs=0.245,95%CI: 0.224～0.266,P<0.001)and TG/HDL-C(rs=0.235,95%CI:0.215～0.256,P<0.001);there was a negative correlation between 2h PG and HDL-C(rs=-0.117,95%CI:-0.140～-0.095,P<0.001);TG was the strongest correlation.4.Multivariate logistic regression analysis showed that the population with TC level in the critical range had a higher risk of pre-diabetes,and the high-risk TC level was 1.544 times of the optimal TC level(95%CI: 1.115～2.138,P=0.013);different TC levels had no significant effect on DM.The risk of pre-diabetes in the high-risk group was 3.045 times higher than that in the critical group(95%CI: 1.936～4.790,P<0.001);the risk of DM in the high-risk group was 4.775 times higher than that in the optimal group(95%CI: 2.644～8.625,P<0.001).Both critical and high-risk levels of TG are risk factors for pre-diabetes and DM.The HDL-C level in the high-risk group was 2.155 times higher than the optimal HDL-C level(95%CI: 1.486,3.126,P<0.001);the HDL-C level in the high-risk group was higher than the critical HDL-C level,which was 3.350 times higher than the optimal HDL-C level(95%CI:1.901,5.902,P<0.001).Critical level of HDL-C is a risk factor for pre-diabetes.Both critical and high-risk levels of HDL-C are risk factors for DM.Different LDL-C levels had no significant effect on pre-diabetes and DM.The risk of pre-diabetes was 2.021 times higher in the high-risk group than in the optimal group(95%CI: 1.496,2.730,P<0.001);the risk of DM was 2.487 times higher in the high-risk group than in the optimal group(95%CI: 1.680,3.680,P<0.001).High risk level of Apo B is a risk factor for pre-diabetes and DM.Compared with the population with TG / HDL-C<1.127,the OR and its 95% CI of pre-diabetes in≥1.841&<3.077 and ≥3.077 were 1.944(1.174,3.220)and 3.258(2.113,5.023),respectively;compared with the population with TG / HDL-C<1.127,the OR and its95% CI of DM in ≥1.841&<3.077 group and≥3.077 group were 2.750(1.248,6.063)and 7.387(3.843,14.199),respectively.In the range of TG / HDL-C≥1.841,with the increase of TG / HDL-C level,the risk of pre-diabetes and DM in adults showed an upward trend.Conclusion:1.From 2007 to 2016,the proportion of pre-diabetic patients in the United States was higher than that of diabetic patients,which was similar to the data published by CDC.2.Compared with TG,Apo B and TG/HDL-C in different blood glucose levels,the diabetic group was higher than the prediabetic group and the normal blood glucose group.Compared with HDL-C in people with different blood glucose levels,diabetic group was lower than prediabetic group and lower than normal blood glucose group.3.In American adult population,FBG and 2h PG were positively correlated with TC,TG,LDL-C,Apo B,TG/HDL-C,and negatively correlated with HDL-C.TG,Apo B,TG/HDL-C were strongly correlated with FBG and 2hPG.4.Dyslipidemia increases the risk of prediabetes and diabetes mellitus,and the risk is similar.Among them,high levels of TG,HDL-C,APO B and high TG/HDL-C increased the risk of prediabetes and diabetes mellitus.