Control of cardiometabolic risk factors and their association with carotid intima media thickness among patients with type 2 diabetes mellitus-single center experience in a developing country.

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Turkish Journal of Medical Sciences Pub Date : 2024-01-11 eCollection Date: 2024-01-01 DOI:10.55730/1300-0144.5821
Thilak Priyantha Weerarathna, Sarath Lekamwasam, Iroshani Kodikara, Keddegoda Gamage Piyumi Wasana, Lakmal Fonseka
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引用次数: 0

Abstract

Background/aim: Type 2 diabetes mellitus (T2DM) is closely associated with atherosclerotic cardiovascular diseases (ASCVD). The objective of this study was to describe the degree of ASCVD risk factor control and their association with carotid intima-media thickness (CIMT) in T2DM patients followed up at a diabetes clinic in Southern, Sri Lanka.

Materials and methods: A crosssectional study was conducted to examine the association between CIMT and nonalcoholic fatty liver disease (NAFLD)in 300 T2DM patients. Both CIMT and its associations with modifiable cardiometabolic risk factors were examined using ultrasonography. The recommended optimal targets for risk factors were defined as glycated hemoglobin (HbA1C) < 7 %, absence of NAFLD, albumin-to-creatinine ratio (ACR) < 30 mg, triglyceride (TG) < 150 mg/dL, low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, high-density lipoprotein cholesterol (HDL-C) in men > 40 and in women > 50 mg/dL, systolic blood pressure (SBP) < 130 mmHg, and diastolic blood pressure (DBP) < 80 mmHg.

Results: SBP, DBP, LDL-C, TG, HDL-C, HbA1C, and ACR were optimally controlled in 59.3%, 75.0%, 46.7%, 84.3%, 46.0%, 33.0%, and 18.7% of patients, respectively. Notably, nearly half of the study subjects did not have NAFLD. Only three patients (1%) had achieved all therapeutic targets. There were statistically significant differences in CIMT between optimally controlled TG and suboptimally controlled TG group (p = 0.027) and between the groups with and without NAFLD (p = 0.045) when adjusted for age and duration of diabetes. CIMT showed significant and positive associations with LDL-C (p = 0.024), TG (p = 0.026), and NAFLD (p = 0.005). Among these, the presence of NAFLD had the highest odds of having higher CIMT when compared to LDL-C and TG.

Conclusion: The majority of patients have not achieved the recommended targets for ASCVD risk factors and are at high risk of ASCVD. It is therefore necessary to identify the reasons for not achieving the treatment targets in order to reduce the ASCVD burden by controlling LDL-C, TG, and NAFLD.

控制 2 型糖尿病患者的心脏代谢风险因素及其与颈动脉内膜厚度的关系--发展中国家单中心的经验。
背景/目的:2 型糖尿病(T2DM)与动脉粥样硬化性心血管疾病(ASCVD)密切相关。本研究旨在描述斯里兰卡南部一家糖尿病诊所随访的 T2DM 患者的 ASCVD 危险因素控制程度及其与颈动脉内膜中层厚度(CIMT)的关系:对 300 名 T2DM 患者的颈动脉内膜中层厚度(CIMT)和非酒精性脂肪肝(NAFLD)之间的关系进行了横断面研究。研究采用超声波检查法检测了 CIMT 及其与可改变的心脏代谢风险因素之间的关系。推荐的风险因素最佳目标是糖化血红蛋白(HbA1C)< 7%、无非酒精性脂肪肝、白蛋白与肌酐比值(ACR)< 30 毫克、甘油三酯(TG)< 150 毫克/分升、低密度脂蛋白胆固醇 (LDL-C) < 100 mg/dL,男性高密度脂蛋白胆固醇 (HDL-C) > 40 mg/dL,女性 > 50 mg/dL,收缩压 (SBP) < 130 mmHg,舒张压 (DBP) < 80 mmHg。结果显示分别有 59.3%、75.0%、46.7%、84.3%、46.0%、33.0% 和 18.7% 的患者的 SBP、DBP、LDL-C、TG、HDL-C、HbA1C 和 ACR 得到了最佳控制。值得注意的是,近一半的研究对象没有非酒精性脂肪肝。只有三名患者(1%)达到了所有治疗目标。经年龄和糖尿病病程调整后,最佳控制 TG 组和次优控制 TG 组之间的 CIMT 差异有统计学意义(p = 0.027),有非酒精性脂肪肝组和无非酒精性脂肪肝组之间的 CIMT 差异也有统计学意义(p = 0.045)。CIMT与LDL-C(p = 0.024)、TG(p = 0.026)和NAFLD(p = 0.005)呈显著正相关。其中,与低密度脂蛋白胆固醇(LDL-C)和总胆固醇(TG)相比,非酒精性脂肪肝(NAFLD)患者具有较高 CIMT 的几率最高:结论:大多数患者的 ASCVD 危险因素未达到建议的目标,是 ASCVD 的高危人群。因此,有必要找出未达到治疗目标的原因,以便通过控制低密度脂蛋白胆固醇、总胆固醇和非酒精性脂肪肝来减轻 ASCVD 负担。
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来源期刊
Turkish Journal of Medical Sciences
Turkish Journal of Medical Sciences 医学-医学:内科
CiteScore
4.60
自引率
4.30%
发文量
143
审稿时长
3-8 weeks
期刊介绍: Turkish Journal of Medical sciences is a peer-reviewed comprehensive resource that provides critical up-to-date information on the broad spectrum of general medical sciences. The Journal intended to publish original medical scientific papers regarding the priority based on the prominence, significance, and timeliness of the findings. However since the audience of the Journal is not limited to any subspeciality in a wide variety of medical disciplines, the papers focusing on the technical  details of a given medical  subspeciality may not be evaluated for publication.
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