Deqiang Zheng and colleagues from China and Canada have discovered a strong association between triglyceride level and glycemic control in patients with type 2 diabetes mellitus (T2DM) who are also taking insulin. Click through the slides below for details on their study and take home points for clinical practice.
High Triglycerides Linked to Poor Glucose Control in T2DM
T2DM and Triglycerides. Tight glycemic control in T2DM is effective in preventing vascular complications, but still large portions of T2DM patients across the world are not achieving recommended A1c levels. Studies have implicated elevated TG levels in the development of T2DM as well as IFG and glucose tolerance. The complex relationship between TGs and T2DM has yet to be determined, so study authors sought to assess the link between TG levels and inadequate glycemic control in T2DM.
The Study. Authors utilized the China National HbA1c Surveillance System study, which was a large, cross-sectional population study that looked at adult T2DM patients. Authors recruited 20 108 T2DM patients from the study who were treated with insulin therapy alone or insulin therapy combined with oral antidiabetic drugs for >3 months. Total cholesterol, TGs, LDL-C, FPG, and A1c data were collected.
The Results. Of the 20 108 patients, 56% had elevated TG levels (≥1.70 mmol/L) and the prevalence of elevated A1c ≥7.0% and ≥6.5%, was 67.2% and 83.4%, respectively. Patients with higher TG levels had a higher prevalence of inadequate glycemic control. The odds ratio of A1c ≥7.0% by TG range (vs patients with TG <1.70 mmol/L) was 1.06 for 1.7-2.29 mmol/L; 1.35 for 2.3-3.39 mmol/L; and 3.12 for ≥3.40 mmol/L.
Take Home Points:
- Elevated TG levels may play an important role in T2DM patients failing to meet glycemic goals
- Strong relationship between TGs and poor glycemic control
- Simply treating T2DM patients with appropriate doses of insulin may be insufficient when TGs are high
- Authors suggest parallel therapeutic strategy to decrease lipid levels while aggressively treating hyperglycemia in T2DM patients
Perspective. "The results of this study highlight the complex interaction between glucose management and independent cardiovascular risk factors like elevated TGs. While it is tempting to say that hyperglycemia in T2DM leads to elevated cardiovascular risk, we know that factors like elevated lipids and hypertension confer risk without the presence of diabetes. These studies are important as they highlight the need for multidimensional approaches to our endocrine patients.”
Reference: Zheng D, Dou J, Liu G, et al. Association between triglyceride level and glycemic control among insulin-treated patients with type 2 diabetes. J Clin Endocrinol Metab. 2018.
