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Variability in total cholesterol and triglyceride levels were linked to the development of type 2 diabetes complications.

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Clinicians should monitor lipid levels in addition to blood glucose in patients with type 2 diabetes, as changes in lipid levels are a pivotal risk factor for diabetes complications, according to findings published in Scientific Reports.

Lead authors Mengjie Chen, Lihui Pu, and colleagues conducted a retrospective study of EHR data from 2013 to 2022 to analyze complications among 369 patients with type 2 diabetes.

“While complications in [patients with diabetes] are influenced by multiple factors, no study to date has concurrently explored the relationship between uric acid and lipid variability and complications,” they explained. “Therefore, this retrospective study aimed to investigate the impact of variable diabetic risk factors on complications and provide clinical evidence for delaying their onset and progression.”

Risk Factor Variability

The study included adult patients who had no diabetic complications at baseline and a minimum of three follow-up visits at a tertiary care hospital. Patients had an average age of 61.92±11.70 years (range, 30-97), and the mean follow-up was 5.14±2.25 years (range, 1-10).

Most patients (70.2%, n=259) were treated for outpatient-specific conditions at the hospital’s endocrinology department. A total of 313 (84.8%) patients developed complications; 85.1% of these patients had two or more complications, and 4.9% had four.

The researchers focused on diabetic peripheral neuropathy, diabetic peripheral vasculopathy, diabetic nephropathy, and diabetic retinopathy. Potential risk factors were uric acid and lipid levels, including triglycerides, total cholesterol, HDL, and LDL. Investigators reported risk factor variability as standard deviation and used binary logistic regression analysis to determine the link between risk factor variability and diabetes complications.

The standard deviations for each risk factor were as follows:

• uric acid: mean 47.68 ± 74;
• total cholesterol: mean 0.62 ± 44;
• triglycerides: median 0.33 (0.20, 0.63);
• HDL: median 0.14 (0.10, 0.17); and
• LDL: median 0.47 (0.30, 0.65).

Men displayed higher variability in uric acid levels (P<0.05), while women had higher variation in HDL. In addition, patients aged 60 years or younger had higher triglyceride and total cholesterol variability (P<0.05). Patients with a follow-up time of 1-3 years had the lowest variability in uric acid and triglycerides (P<0.05).

Lipid Levels Crucial

According to the findings, variation in triglycerides and total cholesterol significantly influenced the occurrence of complications.

Variability in total cholesterol was a risk factor for the development of complications (OR, 2.42; 95% CI, 1.18-4.97), particularly diabetic peripheral vasculopathy (OR, 2.50; 95% CI, 1.25-5.02) and diabetic peripheral neuropathy (OR, 2.29; 95% CI, 1.17-4.50). The researchers also linked age, triglycerides, and total cholesterol to diabetic peripheral vasculopathy (P<0.05).

“Notably, the study included a limited number of patients with a history of diabetic nephropathy (9 participants) or retinopathy (6 participants), which did not meet the requirements for inclusion in the binary logistic regression analysis; therefore, these conditions were not considered in the model analysis,” Chen, Pu, and coinvestigators wrote.

Outpatient Specialty Care’s Role

Outpatient special disease management (OSDM) had a protective effect against the onset of complications (OR, 0.53; 95% CI, 0.29-0.10), especially diabetic peripheral neuropathy (OR, 0.51; 95% CI, 0.30-0.86).

The researchers also found greater variability in HDL among patients receiving OSDM.

“This disparity can be attributed to the fact that patients receiving OSDM benefit from regular and structured follow-up appointments, which include glycosylated hemoglobin monitoring and routine screening for complications conducted every three months. Such diligent monitoring helps patients manage their condition and promotes treatment compliance,” Chen, Pu, and colleagues explained.

The investigators called for more research, such as multicenter studies with prospective designs, to validate the findings and explore the causal relationships between risk factor variability and diabetic complications.

Nevertheless, they concluded that “regular assessment of lipid levels should be incorporated alongside routine blood glucose monitoring” for long-term management of type 2 diabetes, particularly among patients under 60. By prioritizing lipid variability management and promoting specialized outpatient care, clinicians can proactively mitigate the burden of diabetic complications, enhance patient outcomes, and alleviate socioeconomic strains.