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Effect of Elevated Triglycerides on Glycemic Management by Patients with Type 2 Diabetes

Dec 15, 2018
 
Editor: Steve Freed, R.PH., CDE

Author: Michael Zaccaro, Pharm. D. Candidate 2019, LECOM School of Pharmacy

Study attempts to determine association between elevated triglyceride levels and achieving glycemic goals for those with insulin-treated diabetes.

Type 2 diabetes is becoming increasingly prevalent in the developed world, as is evidenced by China’s increase in occurrence from 0.67% in 1980 to 10.9% in 2013. These increases have fostered research concerning the management of diabetes and prevention of complications. From this research, it was found that, in people who have type 2, tight glycemic management reduces the occurrence and slows the progression of micro- and macrovascular damage. Despite this, achieving and maintaining glycemic goals remains difficult for the majority of patients with type 2 diabetes, even with insulin therapy. The cause of this difficulty is likely multifaceted and has been the subject of much research. Several studies have linked elevated triglycerides with an increased risk of developing type 2 diabetes as well as impaired fasting glucose and glucose tolerance. These previous studies have led the authors of this current study to hypothesize that elevated triglycerides may be correlated with inadequate glucose management. Consequently, the aim of this study is to evaluate the association of elevated triglycerides with poor glycemic management in patients with type 2 diabetes.

Since the objective of this study was to establish an association, an observational study design was selected. Participants were chosen from the China National HbA1c Surveillance System (CNHSS). The CNHSS includes people with type 2 who are at least 18 years of age but excludes those whose diabetes is secondary to another disease, who are being treated with Chinese medicine, who are pregnant, or who are nonresponsive / unable to communicate. This study further narrows the inclusion criteria by only considering those treated, for at least 3 months, with insulin or insulin with oral agents. Patients were excluded from participation if they were receiving less than 0.2 units/kg of insulin per day, severe hypo- or hyperglycemia, or any self-reported diabetes complications, hypertension, or dyslipidemia. Once deemed eligible, participant data was collected via face-to-face interview and laboratory analysis (HbA1c, lipid panel, etc.).

Participants were separated into 3 groups based on triglyceride levels (1.7 – 2.29, 2.30 – 3.39, and ≥ 3.40 mmol/L). The triglyceride level was then compared against HbA1c and analyzed for statistical significance via logistic regression.

Of the 238,639 pool of patients who were included in the CNHSS, 20,108 met the eligibility criteria and were included in the study. When the recorded triglyceride levels were compared against HbA1c levels, it was found that the risk of having an HbA1c of greater than or equal to 7.0% increased as the triglyceride levels increased (odds ratio of 1.06, 1.35, and 3.12 for triglyceride levels of 1.7 – 2.29, 2.30 – 3.39, and ≥ 3.40 mmol/L respectively). Likewise, the same association was observed when the risk of having an HbA1c of greater than or equal to 6.5% was considered against triglyceride level.

The results of this study show that elevated triglycerides are strongly associated with increased risk of inadequate glycemic management in patients who have type 2 diabetes and are treated with insulin. While further study is required to determine the full clinical significance of these findings, the evidence suggests that treating elevated triglyceride levels may provide some benefit in achieving and maintaining glycemic goals in people with type 2 diabetes who are treated with insulin.

Practice Pearls:

  • Evidence suggests that there is a strong association between elevated triglyceride levels and increased risk of inadequate glycemic management.
  • Treating elevated triglyceride levels may provide some benefit in achieving and maintaining glycemic goals in people who have type 2 diabetes and are treated with insulin.
  • Further study is required in order to determine the full clinical significance of these findings.

References:

Zheng, Deqiang, et al. “Association Between Triglyceride Level and Glycemic Control Among Insulin-Treated Patients With Type 2 Diabetes.” The Journal of Clinical Endocrinology & Metabolism, Sept. 2018, doi:10.1210/jc.2018-01656.

Beshara A, Cohen E, Goldberg E, Lilos P, Garty M, Krause I. “Triglyceride levels and risk of type 2 diabetes mellitus: a longitudinal large study.” Journal of Investigational Medicine, vol. 64, 2016, pp. 383-387.

Michael Zaccaro, Pharm. D. Candidate 2019, LECOM School of Pharmacy