Dear Fellows,
Looking at Lipid profile of diabetic patients, there are consistent changes in HDL, TC and triglycerides, which can be used as biomarkers for screening/controlling lipid levels in diabetic patients.
High-density lipoprotein (HDL) and Total Cholesterol (TC): decreases
Low-density lipoprotein (LDL): increases and decreases (please see the attached)
Triglycerides: increases
However, levels of LDL are inconsistent due to insulin resistence, which depletes LDL production. This opens to discussion from all Fellows are interested. Thank you!
Regarding your observations:
The pattern you've described is generally accurate for diabetic dyslipidemia, particularly in Type 2 diabetes:
- HDL cholesterol: Typically decreased due to increased catabolism and reduced synthesis
- Triglycerides: Elevated due to increased VLDL production and decreased lipoprotein lipase activity
- Total cholesterol: Often elevated, though this depends on the balance of LDL and HDL changes
Regarding LDL variability:Your point about LDL inconsistency is insightful. However, I'd suggest a slight refinement in the mechanism. Rather than insulin resistance directly "depleting LDL production," the relationship is more complex:
Additional considerations for biomarker utility:
- Non-HDL cholesterol might be a more reliable marker than LDL alone in diabetic patients
- ApoB/ApoA1 ratio could provide better cardiovascular risk assessment
- Remnant cholesterol is increasingly recognized as important in diabetic dyslipidemia
LDL should not be viewed as a “biomarker” in this context, but rather as the primary therapeutic target (see ESC 2021 guidelines for CV prevention) in the management of cardiovascular risk in diabetic patients.
Yes we can consider LDL as good biomarker for hyperlipidemia in Diabetes.
It is agreed that certain disturbances in Lipid profile in uncontrolled diabetes where a significant increase in cholesterol and TG may be observed her indeed LDL may be expressed as good biomarker her.
I do not fully agree with you, dear Mohamed Elseweidy. LDL-C is usually only mildly elevated in diabetes mellitus and reflects beta-cell hyperfunction secondary to insulin resistance, as insulin promotes its synthesis (stimulating HMG-CoA-reductase). It is not related to hyperglycemia itself, being related to an early stages of the disease. Later, when beta cells begin to fail and insulin levels decline, this stimulatory effect also decreases.
At the same time, the drop in insulin leads to increased lipolysis, raising free fatty acids (FFAs), which drive hepatic VLDL overproduction and result in elevated triglycerides.
HDL-C levels decrease due to CETP-mediated exchange with VLDL and reduced synthesis of ApoA-I. Thus, the typical diabetic lipid profile is characterized by low HDL-C and high triglycerides.
LDL-C remains the primary cardiovascular target due to strict prevention guidelines. Triglycerides are treated mainly when severely elevated and unresponsive to lifestyle modifications or glycemic control.
To end, LDL-C are a therapeutic target, not a ''biomarker''.
In diabetics, as noted above, the usual lipid abnormality is a low HDL-c, with relatively mild elevations of LDL-c. I find that the most useful lipid abnormality in diabetics is an abnormal ratio between LDL-c and HDL-c. I prefer the Cholesterol Retention Fraction, defined as (LDL-c mnus HDL-c)/LDL-c. This should be 0.49 or lower, assuming that the measurement of HDL-c is by the enzymatic method. (If HDL-c is measured by the precipitation method, then the goal is 0.59.) If you only want to use LDL-c, then the goal is 89 mg/dl (enzymatic method of HDL-c measurement) or 99 mg/dl (precipitation method of HDL-c measurement). If you think that the patient already has atherothrombotic disease, lower the goals to 69 mg/dl and 79 mg/dl respectively That would be 2.0 and 1.75 mmoles/L respectively. I hope that this helps.
Dear Mohamed Elseweidy and William Feeman , thank you for your responses!
Dear Mohamed Elseweidy. I do not agree with you on this suggestion.LDL-C is usually variably elevated in diabetes mellitus type 2 and cannot be used as a biomarker for disease activity , prognosis and repsonse to threrapy of diabetes as such. It can be used to follow the treatment of hypercholestroleamia by statins but noyt diabetes itself .Becuaes of its varaibility in DMt 2, it can hardly be used as a biomarker for dyslipidemia as well .Actually patients with DM , have to have their lipids ascertained , essentially HDL and TG once DM is diagnosed because they are disturbed secondarily due to insulin resistance.A full lipids profile may be requested depending on the resources and affordability,but usually HDL,TG, and LDL are enough .
- Badges
- Science topic
- Similar topics
- Methodology
- Laboratory