Novel Lipid Biomarkers and Microvascular Complications in Patients with Diabetes Mellitus: A Systematic Review and Meta-analysis.

Abstract

Background: Emerging lipid-related biomarkers, including the Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), and Atherogenic Index of Plasma (AIP), have demonstrated potential in predicting metabolic disorders such as diabetes mellitus (DM) and associated microvascular complications, particularly diabetic kidney disease (DKD) and diabetic retinopathy (DR).

Objectives: This systematic review and meta-analysis aims to evaluate the association between these biomarkers and microvascular complications in individuals with DM, as well as to assess their diagnostic performance.

Data sources and methods: A systematic literature search was performed in PubMed, Scopus, Embase, and Web of Science following PRISMA guidelines. Eligible studies examined the relationship between VAI, LAP, and AIP and microvascular complications in DM. The meta-analysis synthesized data using pooled weighted mean differences (WMDs) and area under the receiver operating characteristic curve (AUC) values to evaluate the predictive utility of these biomarkers for DKD and DR.

Results: A total of 23 studies were included. Patients with DKD had significantly higher levels of LAP (WMD: 12.67; 95% CI: 7.83-17.51; P < .01), AIP (WMD: 0.11; 95% CI: 0.03-0.19; P < .01), and VAI (WMD: 0.63; 95% CI: 0.38-0.89; P < .01) compared to those without DKD. Additionally, each 1-unit increase in LAP (OR: 1.005; 95% CI: 1.003-1.006; P < .01), AIP (OR: 1.08; 95% CI: 1.04-1.12; P < .01), and VAI (OR: 1.05; 95% CI: 1.03-1.07; P < .01) was associated with an elevated risk of DKD. In contrast, no significant associations were identified between these biomarkers and DR. The diagnostic performance of VAI, LAP, and AIP was limited for both DR and DKD, with low discriminatory power.

Conclusion: VAI, LAP, and AIP are significant predictors of DKD in individuals with DM but exhibit limited relevance for the detection of DR. Although these biomarkers show potential in identifying DKD risk, their overall diagnostic accuracy for DKD and DR remains modest, underscoring the need for further studies to enhance their clinical applicability.