Association between Fasting & Postprandial Triglyceride Levels & Carotid Intima-Media Thickness in Type 2 Diabetes Patients

Jami, Swathi (2012) Association between Fasting & Postprandial Triglyceride Levels & Carotid Intima-Media Thickness in Type 2 Diabetes Patients. Masters thesis, Stanley Medical College, Chennai.


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BACKGROUND: Cardiovascular disease is the major cause of mortality and morbidity in individuals with diabetes. More than 70 % of the deaths in individuals with diabetes is accounted by the macrovascular complications associated with it, namely- coronary heart disease, peripheral vascular disease and cerebrovascular accidents. Diabetic dyslipidemia plays an important role in the pathogenesis of accelerated atherosclerosis. It consists of elevated triglycerides, low HDL and increased small dense LDL (sLDL). In the recent times, triglyceride levels have emerged as an independent risk factor for atherosclerosis. Diabetes is predominantly a post prandial metabolic disorder. Serum triglycerides generally increase maximally 3-6 hours after a meal, more so in diabetics. Once postprandial triglyceridemia occurs, it is further exacerbated by the next meal. As we stay in a post prandial state for most of the day, measurement of serum triglycerides in both fasting and postprandial state may provide a more reliable estimate of hypertriglyceridemia among diabetics. As the carotid intima media thickness (CIMT) is a surrogate marker of atherosclerosis, to investigate the role of fasting and postprandial hypertriglyceridemia in early atherosclerosis, there is a need to correlate the triglyceride levels and carotid intima media thickness values. OBJECTIVES: To investigate the extent of association between fasting and postprandial triglyceride levels and carotid intimal thickness in patients with type 2 diabetes mellitus. MATERIAL & METHODS: This is a comparative study in which 100 type 2 diabetic patients in the age group of 35-65 years ,with average duration of diabetes between 1-5 years, are included. STANDARDIZED MIXED MEAL TEST: Subjects underwent a standardized mixed meal test after an overnight fast. The total energy content of the meal was 9Kcal/kg, with 20% of energy from fat, 60 % from carbohydrate, 20 % from protein. Blood samples for lipid profile were taken before, and 4 hrs after the standardized meal. Measurement of carotid IMT : By Doppler studies: Carotid artery Doppler was done by B-mode ultrasound using a 7.5 MHZ transducer. Inclusion criteria: (a) type 2 Diabetes patients, (b) HbA1C< 7%. Exclusion Criteria: (a) Patients receiving lipid lowering agents, thiazides, beta blockers. (b) Known cases of hypothyroidism not on thyroxine replacement therapy. (c) Patients with chronic complications of diabetes such as nephropathy, hepatic disease, current h/o alcoholism & smoking and existing IHD as determined by history & ECG. (d) Patients who had CVD (by history & clinical examination). (e) Patients with history/clinical findings suggestive of familial hyperlipidemias. Patients receiving OHAs, antihypertensives (ACE inhibitors or AT II antagonists) and antiplatelet drugs were not excluded from the study. STATISTICAL ANALYSIS: Data was entered in windows excel format. Frequency tables and measures of central tendency (mean) and measures of dispersion (Standard deviation) were obtained by using the statistical package SPSS -20. RESULTS: The study population was divided into 3 groups based on their fasting and postprandial triglyceride levels. NORMO-NORMAL (NN) GROUP: This group consisted of subjects with normal fasting triglyceride level (=150 mgs/dl) and normal postprandial triglyceride levels (=200 mgs/dl). NORMO-HYPER (NH) GROUP: This group consisted of subjects with normal fasting triglyceride level (=150 mgs/dl) and elevated postprandial triglyceride levels (>200 mgs/dl). HYPER – HYPER (HH) GROUP: This group consisted of subjects with elevated fasting triglyceride level (>150mgs/dl) and elevated postprandial triglyceride levels (>200 mgs/dl). CONCLUSION: The conclusion of the present study is that there is a correlation between postprandial hypertriglyceridemia and carotid intima- media thickness (CIMT)

Item Type: Thesis (Masters)
Uncontrolled Keywords: Diabetic dyslipidemia ; Fasting triglycerides (fTG) ; Postprandial triglycerides (ppTG) ; Carotid Intima Media Thickness (CIMT).
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 25 Mar 2018 05:59
Last Modified: 27 Mar 2018 14:43

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