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REVIEW ARTICLE
Year : 1998  |  Volume : 5  |  Issue : 1  |  Page : 45-50  

Hyperlipidemia and obesity among diabetics at Jubail miiltary hospital


Armed Forces Hospital, Jubail, Saudi Arabia

Date of Web Publication31-Jul-2012

Correspondence Address:
Khalid S Al-Ghamdi
P.O. Box 3473, Almadina Almunawara
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


PMID: 23008582

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   Abstract 

Objective: Evaluate the pattern of dyslipidemia and obesity among diabetics, attending the Primary Care Clinic.
Subjects and Methods: All diabetics (282) registered in the Primary Care Clinic of the Armed Forces Hospital at King Abdulaziz Naval Base, Jubail, Eastern Saudi Arabia, were interviewed by primary care doctors.Weight and height were recorded; fasting blood glucose and cholesterol levels were measured after 12-hour fasting.
Results: The study revealed that among 89.7% type 2 and 10.3% type 1 diabetes mellitus, 22.7% had a normal Body Mass Index (BMI) 40.8% were overweight, and 36.5%, obese. Females had a significantly higher BMI than males (P<0.001). Total cholesterol was more than normal in 26%, LDL in 27% and Triglycerides in 11% but HDL lower than normal in 38%. However, mixed hyperlipidemia was seen in 5% of the study population.
Conclusion: Obesity and dyslipidemia were high among diabetic patients and special attention is required in prevention and treatment.

Keywords: Diabetes mellitus, lipids, hypercholesterolemia, BMI, obesity.


How to cite this article:
Al-Ghamdi KS, Rehman R. Hyperlipidemia and obesity among diabetics at Jubail miiltary hospital. J Fam Community Med 1998;5:45-50

How to cite this URL:
Al-Ghamdi KS, Rehman R. Hyperlipidemia and obesity among diabetics at Jubail miiltary hospital. J Fam Community Med [serial online] 1998 [cited 2019 Dec 15];5:45-50. Available from: http://www.jfcmonline.com/text.asp?1998/5/1/45/98392


   Introduction Top


Diabetes mellitus is one of the secondary causes of hypercholestrolemia. [1] Hypercholesterolemia in diabetics is an additional risk factor for coronary heart disease (CHD), [2],[3] therefore, mortality and morbidity due to CHD are higher among those patients. [4] It was documented that abnormal plasma lipid level is frequently seen in diabetics especially triglycerides. [5]

Hyperlipidemia has been investigated in the Kingdom among healthy adults [6] and patients. [7] However, hyperlipidemia among diabetics has only recently been studied. [8],[9]

These and other factors have urged the authors to evaluate the pattern of dysplipidemia and obesity among diabetics attending the Primary Health Care (PHC) Center in the Military Hospital, Jubail, in the Eastern Province of Saudi Arabia.


   Material and Methods Top


A total of 282 diabetic patients were registered at the diabetic clinic in the Primary Care Department at this Military Hospital from 1994 (the date when the diabetic clinic first started) through 1996. Complete history, physical examination, and investigations were done on every patient registered in this clinic.

Two nurses were assigned to this clinic after some training. Weight was measured with a previously calibrated weighing machine and height measured by those nurses. Both were recorded to the nearest decimal point.

Among the different investigations done for those patients were the fasting serum lipids. Other investigations, such as fasting plasma glucose and HbA1c were not used in this particular study.

Fasting serum lipids were done on a sample of blood after fasting for 12 hours. The method used for determining the cholesterol and trigylcerides levels in the laboratory was the Enzmatic method (CHILL). The BMI (which is weight divided by the square of the height) was used to assess the degree of obesity. The BMI was considered normal if it was below 25 kg/m [2] , 25-29.9 kg/m [2] overweight and 30 kg/m [2] or greater was obese. [10] According to the national cholesterol education program, [2] the total cholesterol was considered high if it was >6.2 m mol/L and low density lipoprotein (LDL) >4.15 m mol/L. High density lipoprotein (HDL) was regarded low <0.9 m mol/L.

All statistics were done with a personal computer using Epi-Info program. Statistics used in this study were the Chi-Squared and Student "T" test.


   Results Top


There were 282 diabetic patients attending the diabetic clinic at the Primary Care Department. Two hundred and fifty three were type II diabetes mellitus (89.7%) and the rest were type I (10.3%). Their ages ranged from 19 years to 91 years of age with a mean (SD) of 46 years ± 12.98.

[Table 1] shows the distribution of the different groups of BMI with their sexes. There were 212 male patients (75.2%) and 70 females (24.8%). Sixty-four of the attending patients had a normal (<25 kg/m [2] ) BMI, 115 patients (40.8%) were over weight and 103 patients (36.5%) obese. The females had a significantly higher BMI than the males (p<0.001).
Table 1: The body mass index among the genders

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[Table 2] shows that the total cholesterol level was high (>6.2 m mol/L) in 73 patients (26%). There was no significant difference between the two types of diabetes (P=0.65). Low density lipoprotein was high (>4.15 m mol/L) in 76 patients (27%). On the other hand, the HDL was low (<0.9 m mol./L) in 108 patients (38%). The triglycerides were high (>4.5 m mol/L) in 32 patients (11%). Mixed hyperlipidemia (high cholesterol and triglycerides) was found in 13 diabetic patients (5%).
Table 2: Distribution of diabetic patients having dyslipidemia

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In [Table 3], it is shown that diabetic males had a lower level of total cholesterol and LDL than females. However, this difference was not statistically significant (p=0.245 and 0.444, respectively). Whereas the females had slightly higher levels of HDL than males the difference was significant p<0.001. However, the triglycerides levels were slightly lower among diabetic females than males but the difference did not attain statistical significance.
Table 3: Distribution of the mean value of lipids among the genders

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   Discussion Top


Conflicting views have been reported in several studies [2],[3],[4],[5] about obesity as an independent risk factor for CHD. However, the studies agree on the association between obesity and hypercholesterolemia.

In this study, female diabetics had higher BMI than males (p<0.001), which is consistent with the previous finding by Khandekar in 1994 in the Kingdom of Saudi Arabia. [8] High intake of calories and fats may be attributed to the vast improvement in the economy of the country. This has influenced the change in dietary habits of the people.

It was alarming to see that 55.7% of the female diabetics were found to be obese compared to 30.2% of the males (i.e., BMI ≥ 30 kg/m [2] ). This may be partially explained by the fact that most females in Saudi Arabia lead a sedentary life style indoors with little exercise.

Most males, however, have a more active lifestyle. Most of the males in this study were in the military and performed a variety of activities and exercise.

Atherosclerosis accounts for a considerable percentage of all diabetic mortality, the majority of which is the consequence of coronary artery disease. Hyperlipidemia is an important cause for atherosclerosis. This study shows the distribution of the different types of dyslipidemia among our diabetic patients.

One quarter of the study population had hypercholesterolemia. Al-Nuaim [9] reported 14% hypercholesterolemia among his diabetics in 1995. This figure is increasing with time, so the problem requires serious intervention in the form of health education, dietary instructions, and physical exercises.

It was reported that hypertriglyceridemia is associated with low HDL among diabetics. [2],[4] Low density lipid is considered as an independent risk factor for CHD with levels > 4.15 mmol/L. Twenty seven percent of the study population had this risk. None of the above mentioned references reported their mean level of LDL.

The serum level of HDL was found to be low in 38% of the study population. This is the highest among the different types of dyslipidemia. A high level of HDL is considered a negative risk factor for CHD. Therefore, it is important to study this high proportion of diabetics in greater detail. Hypertriglyceridemia was seen in 11% of this study population and this is similar to the figure (15%) reported by Al-Nuaim. [9] Reports from elsewhere by Stern et al [11] showed a higher percentage (23%). The different race, socioeconomic state, and dietary habit may explain this.

In an early study by Bacchus in 1982 [12] the cholesterol levels among healthy subjects, in this country, were reported as 4.27 m mol/L among males and 4.23 m mol/L among females. In 1991, Inam [7] reported a level of 5.25 m mol/L among males and 5.49 m mol/L among females. However, in 1985 the cholesterol level among diabetics in this country was reported as 5.2 m mol/L among non-insulin dependent diabetes mellitus (NIDDM). [13] In this study, the mean cholesterol level among all the diabetic males was found to be 5.49 m mol/L and 5.71 m mol/L among diabetic females. These figures are very close to the levels reported by Khandekar [8] (i.e., 5.52 m mol/L for males and 5.97 m mol/L for females). Khandekar used the same method to determine cholesterol and triglycerides levels in a Saudi diabetic population.

The higher level of HDL among females than males is another evidence of the positive effect of estrogen, as previously documented. [14]

The study revealed that obesity and dyslipidemia were high among diabetic patients and required special attention. This can be done through health education at the primary care level and the diabetic clinics. More health education on diet is required particularly for females with the help of the primary care physicians and the media.

 
   References Top

1.Blake GH, Triplett LC. Management of hypercholesterolemia. American Family Physician 1995;51(5):1157-66.  Back to cited text no. 1
    
2.Summary of the second report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel II). JAMA 1993;269(23):3015-23.  Back to cited text no. 2
    
3.Haffner SM, Stern MP, Hazuda HP. Role of obesity and fat distribution in non-insulin dependent diabetes mellitus in Mexican American and non-Hispanic whites. Diab Care 1986;9:153-61.  Back to cited text no. 3
    
4.Betteridge DJ. Diabetic dyslipidemia. Am J Med 1994; 96(6A):25S-31S.  Back to cited text no. 4
    
5.Guerci B, Ziegler O. Hyperlipidemia during diabetes mellitus. Recent developments. Presse Med 1994; 23(2):82-8.  Back to cited text no. 5
    
6.Mitwalli AH, AlMaatouq MA, AlWakeel J, Alam AA. Hypercholesterolemia in health adult males. A public survey in central Saudi Arabia. Ann Saudi Med 1994;14(6):499-502.  Back to cited text no. 6
    
7.Inam S, Cumberbatch M, Judzewitsch R. Importance of cholesterol screening in Saudi Arabia. Saudi Medical Journal 1991;12(3):215-20.  Back to cited text no. 7
    
8.Khandekar S, Noeman SA, Muralidhar K, Gadallah M, Al-Sawaf KS. Central adiposity and atherogenic lipids in Saudi diabetics. Ann Saudi Med 1994;14(4):329-32.  Back to cited text no. 8
    
9.Al-Nuaim A, Famuyiwa O, Greer W. Hyperlipidemia among Saudi diabetic patients - pattern and clinical characteristics. Ann Saudi Med 1995;15(3):240-3.  Back to cited text no. 9
    
10.Foster DW. Eating disorders: obesity, anorexia nervosa, and bulemia nervosa. In: Maxcy-Rosenau, editor. Public Health and Preventive Medicine. 12 th ed. California: Appleton & Lange; 1986:1335-59.  Back to cited text no. 10
    
11.Stern MP, Patterson JK, Haffner SM, Hazuda HP, Mitchell BD. Lack of awareness and treatment of hyperlipidemia in type II diabetes in a community survey. JAMA 1989;262(2): 360-4.  Back to cited text no. 11
    
12.Baccus RA, Kilshaw BM, Madkour MM. Establishment of male Saudi Arabian reference ranges from biochemical analysis. Saudi Med J 1982;3:249-58.  Back to cited text no. 12
    
13.Kinggston M, Skooge WC. Diabetes in Saudi Arabia. Saudi Med J 1986;7:130-42.  Back to cited text no. 13
    
14.Gambrell RD. Update on hormone replacement therapy. Am Family Physician 1992;46:87S-96S.  Back to cited text no. 14
    



 
 
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