Extended lipid profile and urine albumin-creatinine ratio in type 2 diabetes mellitus

Background: Diabetes is a chronic metabolic disorder and has become the one of the most challenging global health problem of 21 st centuary. Diabetic nephropathy is a major complication of diabetes and an established risk factor for cardiovascular events. Lipid abnormalities occur in patients with diabetic nephropathy, which further increase their risk for cardiovascular events. We aimed to research association between extended lipid profile and urine albumin-creatinine ratio (UACR), hypothesizing that early detection and treatment of lipid abnormalities can minimize the risk for atherogenic cardiovascular disorder and cerebrovascular accident in patients with type 2 diabetes mellitus. Methods: A hospital based cross- sectional study was conducted on 48 patients with type 2 diabetes mellitus. All patients fasting blood glucose (FBG), HbA1c, total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG), apolipoprotein-A (apo-A), apolipoprotein-B (apo-B), lipoprotein (a){Lp(a)} and urine-albumin creatinine ratio (UACR) evaluated. Patients taking steroids, any renal disease other than diabetic nephropathy and patients of uncontrolled hypertension were excluded from study. Based on UACR level patients were divided into three sub groups: normal (<30 mg/g), microalbumiuria (30-300 mg/g) and macroalbuminuria (>30 mg/g). Comparison between three subgroups of UACR and extended lipid profile was made using non parametric test (Kruskal Willis Test). Fisher’s exact test was used to explore the association between UACR and extended lipid profile. Result: 20.8% patients had UACR<30 mg/g, 54.2% patients had UACR:30-300 mg/g, 25.0% patients had UACR:≥300 mg/g; 62.5% patients had Lipoprotein(a): <30 mg/dl and 37.5% patients had Lipoprotein(a): > 30 mg/g. Significant association was found between UACR and Lipoprotein(a): · 100.0% of the patients with [UACR: <30 mg/g] had [Lipoprotein-a: <30mg/dL]. · 57.7% of the patients with [UACR: 30-300 mg/g] had [Lipoprotein-a: <30 mg/dL]. · 42.3% of the patients with [UACR: 30-300 mg/g] had [Lipoprotein-a: ≥30 mg/dL]. · 41.7% of the patients with [UACR: >300 mg/g] had [Lipoprotein-a: <30 mg/dL]. · 58.3% of the patients with [UACR: >300 mg/g] had [Lipoprotein-a: ≥30 mg/dL]. Conclusion: The study showed that diabetic nephropathy resulting in raised UACR has significant association with increased lipoprotein (a) and consequently increased risk of atherosclerotic cardiovascular disease (ASCVD). Since Lipoprotein(a) investigation is not widely available, accessible and has varied estimation technique, UACR can be used as a marker of risk for ASCVD in place of Lipoprotein(a) in type 2 DM.