Are blood lipids associated with microvascular complications among type 2 diabetes mellitus patients? A cross-sectional study in Shanghai, China

Abstract

Background: Although there are several studies to investigate the association between blood lipids and microvascular complications, these studies reported conflicting results. The aim of the current study was to explore the association between blood lipid parameters and the risk of microvascular complications, especially the dose-response association between them, among community patients with type 2 diabetes mellitus (T2DM) in Shanghai, China.

Methods: The cross-sectional study was conducted in 6 community health service centers in Shanghai between December 2014 and December 2016.The associations between blood lipids and diabetic kidney disease (DKD) or diabetic retinopathy (DR) were assessed using multiple logistic regression. Restricted cubic spline (RCS) was employed to estimate the dose-response relation of blood lipids and the risk of microvascular complications.

Results: A total of 3698 participants were included in the final analysis to study the association between blood lipids and DKD, wherein 33.2% of participants had DKD and 1374 were included for the analysis of the association between blood lipids and DR, wherein 23.2% of participants had DR. DKD odds ratio was increased by 1.16(95%CI,1.08-1.25), 1.21(95%CI,1.13-1.30), 1.18(95%CI,1.10-1.26) for comparing fourth to first quartiles of triglycerides (TG), TG/high-density lipoprotein cholesterol (HDL-C), non-HDL-C/HDL-C, respectively, and decreased by 0.83(95%CI,0.78-0.89) for comparing fourth to first quartiles of HDL-C. Furthermore, the dose-response association between TG, HDL-C, TG/HDL-C, non-HDL-C/HDL-C and the risk of DKD demonstrated turning points in TG of 1.90 mmol/L, HDL-C of 1.62 mmol/L, TG/HDL-C of 2.00, non-HDL-C/HDL-C of 3.09, respectively. However, no significant association was found between blood lipid parameters and DR.

Conclusions: This community-based study indicated that TG, HDL-C, TG/HDL-C, non-HDL-C/HDL-C were independently associated with DKD but not DR.

Keywords: Blood lipids; Diabetic kidney disease; Diabetic retinopathy; Type 2 diabetes mellitus.

Fig. 1

Inclusion/exclusion criteria of the study participants for assessing the association between blood lipids and microvascular complications. ^*: Invalid UACR was defined as having microscopic hematuria or microscopic leucocyturia in urine routine. ^△: Nondiabetic Kidney Disease (NDKD) was determined by physicians according to medical history and records of the participant

Fig. 2

Odds ratio (OR) for participants with diabetic kidney disease, comparing fourth to first quartiles of TC, TG, LDL-C, HDL-C, Non-HDL-C, TG/HDL-C, or Non-HDL-C/HDL-C. This was performed after adjusting for age, sex, family history of diabetes mellitus, duration of diabetes mellitus, current medical treatment, smoke status, comorbid hypertension, CAD, stroke, BMI, HbA1c, SBP

Fig. 3

RCS on the dose-response relationship of TG, HDL-C, TG/HDL-C, Non-HDL-C/HDL-C and the risk of DKD, respectively. This was performed after adjusting for age, sex, family history of diabetes mellitus, duration of diabetes mellitus, current medical treatment, smoke status, comorbid hypertension, CAD, stroke, BMI, HbA1c, SBP. The dotted lines presented 95%CI

Fig. 4

Odds ratio (OR) for participants with diabetic retinopathy comparing fourth to first quartiles of TC, TG, LDL-C, HDL-C, Non-HDL-C, TG/HDL-C, or Non-HDL-C/HDL-C. This was done by adjusting for age, sex, family history of diabetes mellitus, duration of diabetes mellitus, current medical treatment, smoke status, comorbid hypertension, CAD, stroke, BMI, HbA1c, SBP