Association between Postsprandial triglyceride levels and urinary albumin excretion in Type II Diabetic Subjects - A case-control study in North Indian Population

Aim: To evaluate and correlate 2-hour postprandial lipid profile and urine albumin excretion in patients with type II Diabetes Mellitus. Method: This case-control study included 148 subjects with Type II Diabetes mellitus and 96 age and gender matched healthy controls. Fasting and 2-hour postprandial blood samples were collected from all subjects and analyzed for plasma glucose, serum insulin, serum cholesterol, triglycerides and high-density lipoproteins. In addition fasting samples were analyzed for glycated haemoglobin (HbA1c) and kidney function tests. Percentage retention of triglyceride in plasma at the end of two hours and HOMA-IR as a measure of Insulin resistance was calculated. Spot urine sample collected from all subjects within two hours waiting period was analyzed for urine albumin/ creatinine ratio. Statistical evaluation of data was done on SPSS and Medcalc online software. Result: Plasma glucose, insulin and HbA1c levels were significantly higher in diabetic subjects as compared to control group (p<0.01). Serum cholesterol and HDL levels did not have a significant difference in fasting and postprandial state in both groups. The difference in triglyceride levels between study and control group was insignificant in fasting state (p=0.051) but highly significant in postprandial state (p<0.001). Percentage triglyceride retention in plasma after 2 hours was significantly higher in diabetic patients [16.43 ± 28.25%] as compared to control group [2.56 ± 19.17%] (p=0.002). Postprandial serum triglyceride levels in diabetic subjects showed a highly significant positive correlation with urinary albumin excretion in these subjects (r= 0.444, p<0.001).Odds ratio for presence of hypertriglyceridemia in patients with microalbuminuria was 18.667 (95% CI of 6.64 to 52.45, z-static-5.55, P< 0.0001). Conclusion: Diabetic subjects excreting micro-albumin in urine have exaggerated postprandial lipidemia as compared to patients with no micro-albumin excretion and normal subjects. This may be regarded as one of the mechanisms by which microalbuminuria in diabetic patients contributes to increased cardiovascular risk.