
































Microsoft Word - FIN-6129-Article Text-22203-1-4-20220630-7 Feb 2023.edited.docx


 

 Epidemiology and Society Health Review| ESHR 
Vol. 5, No. 2, 2023, pp. 60-68 ISSN 2656-6052 (online) | 2656-1107 (print) 
      http://journal2.uad.ac.id/index.php/eshr/index                                                   eshr@ikm.uad.ac.id 

 

 

      10.26555/eshr.v5i2.6129  

 
 

60 

 
 

  

 
Research Article  
 
Correlation between HbA1c and lipid profile in diabetes:  a 
primary health concern in Aseer, Saudi Arabia 
 
Fatima Riaz1 and Archana Nimesh2* 
 
1 Department of Family and Community Medicine, College of Medicine, King Khalid 

University, Saudi Arabia 
2 Department of Clinical Biochemistry, College of Medicine, King Khalid University, Saudi 

Arabia 
 
* Correspondence: archana.akku.2010@gmail.com. Phone: +966-594261524  
 
Received 04 June 2022; Accepted 07 February 2023; Published 30 July 2023  
 

ABSTRACT 

Background: Type 2 diabetes mellitus (T2DM) presently affects 537 million adults globally. 
It has a high prevalence in the Saudi population (31.6%), ranking 2nd highest in the Middle 
East and 7th worldwide. T2DM is characterized by insulin resistance and hyperglycemia, 
causing the glycation of hemoglobin, plasma proteins, tissue proteins, and their receptors. 
The high insulinemic state leads to dyslipidemia. These biochemical alterations can cause 
complications like atherosclerosis, coronary artery disease, angina, myocardial infarctions, 
and hypertension. Considering the high prevalence of diabetes in the Saudi population and 
the lack of studies conducted at primary health care (PHC) centers in Saudi Arabia, this 
study was done to investigate the status of diabetes control in T2DM patients and propose 
appropriate measures to prevent the development of future complications. 
Method: This cross-sectional study recruited 191 known T2DM patients presenting at the 
PHC center in the Al Qabil locality of Aseer province of Saudi Arabia. The patient's 
demographic and glycemic and lipid profile data were recorded and statistically analyzed. 
Results: T2DM was more prevalent in males. T2DM patients were found to be obese, and 
52% had coexisting hypertension. Patients had deranged glycemic profiles and dyslipidemia 
despite taking hypoglycemic agents. Hyperglycemia and dyslipidemia were significantly 
higher in people with diabetes having HbA1c > 7. HbA1c is correlated with dyslipidemia, 
and dyslipidemia is linked considerably with obesity. 
Conclusion: T2DM patients must be regularly followed up to ensure drug compliance, 
explained about foreseen medical complications, and motivated to adopt lifestyle 
modification measures to control their weight, BP, and blood glucose. 

Keywords: Correlation; HbA1c; lipid profile; Type 2 diabetes mellitus; Saudi Arabia 



 
Riaz (Correlation between HbA1c and lipid profile in diabetes:  a health concern in Aseer, Saudi Arabia) 

 
 

 
Vol. 5, No. 2, 2023, pp. 60-68 61   10.26555/eshr.v5i2.6129 

  

INTRODUCTION 

Type 2 diabetes mellitus (T2DM) is one of the most commonly encountered metabolic 
disorders in clinical practice and communities worldwide. The prevalence of this chronic 
disorder is increasing at an alarming rate globally. Presently 537 million adults are living with 
diabetes worldwide, accounting for about one diabetic person in every ten persons (according 
to the year 2021 data), and this number is predicted to rise to 643 million by 2030 and 783 
million by 2045.1 The prevalence of diabetes in Saudi population2 is 31.6% which is relatively 
high and Saudi Arabia is ranked as the 2nd highest country in the Middle East zone and 
seventh in the world regarding the prevalence of diabetes mellitus.3 

Type 2 diabetes mellitus is characterized by insulin resistance leading to hyperglycemia which 
consequently leads to further biochemical derangements in the body leading to the 
development of a vast array of clinical complications in due course of time. Insulin resistance 
leads to a hyperinsulinemia state in the body in an attempt to bring down the blood glucose 
levels by trying to facilitate the entry of plasma glucose into the tissue cells. This high insulin 
level leads to dyslipidemia in the body, thereby increasing the propensity to develop 
cardiovascular complications. Besides this, hyperglycemia leads to the glycation of 
hemoglobin, plasma proteins, tissue proteins, and their receptors. These biochemical 
alterations over a chronic period have been known to cause several complications, especially 
atherosclerosis, coronary artery disease, angina, myocardial infarctions, hypertension, stroke, 
obesity, retinopathy, neuropathies, nephropathy, and xanthelasmas.4 Moreover, it is not 
uncommon to see patients presenting to the medical emergency department having diabetic 
ketoacidosis or hyperosmolar coma due to poorly controlled diabetes mellitus. Thus, it 
becomes essential that a patient, once diagnosed with diabetes, is strictly followed up clinically 
to prevent the development of these medical sequelae that leads to depreciation in their quality 
of life. 

This study has been carried out in the primary health care (PHC) center of the Aseer region 
on known cases of type 2 diabetes mellitus patients because primary health care serves as 
the first interface of interaction with patients to provide healthcare to the community. Due to 
the increasing prevalence of diabetes among the Saudi population and the lack of studies 
conducted at the primary healthcare level in Saudi Arabia, this study was conducted to 
investigate the status of diabetes control in T2DM patients and if they had dyslipidemia or not 
and to propose appropriate measures to be adopted at primary health care level that could 
help serve the community in a better way to battle this disease that silently affects almost all 
tissue of the body. 

METHOD 

This cross-sectional study was carried out after taking ethical permission from our 
organization's scientific committee of research. Informed consent was taken from the patients 
to recruit them for the study. The known cases of type 2 diabetes mellitus who presented to 
the primary health care center (situated at Al-Qabil locality of the Aseer province of Saudi 
Arabia) for their follow-up were the subjects of this study. Only patients with type 2 diabetes 
mellitus with at least one year of duration were included in the study. The study was conducted 
for ten months, from April 2019 to January 2020, and 191 T2DM patients were recruited in the 



 
Riaz (Correlation between HbA1c and lipid profile in diabetes:  a health concern in Aseer, Saudi Arabia) 

 
 

 
Vol. 5, No. 2, 2023, pp. 60-68 62   10.26555/eshr.v5i2.6129 

  

study group. Diabetic patients who were taking drugs causing hypolipidemia were excluded 
from the study. Patients having a history of any other metabolic disorder were excluded from 
the study to avoid getting confounding results. Type 1 diabetes patients and newly diagnosed 
type 2 diabetics were also excluded from the study. The patients' demographic data were 
recorded and then asked to undergo biochemistry lab investigations to check their glycemic 
and lipid profile status. The socio-demographic data included age, gender, body mass index 
(BMI), blood pressure (BP), and nationality. The glycemic profile of the patients was checked 
by measuring fasting blood glucose (FBS), random blood glucose (RBS), and glycated 
hemoglobin (HbA1c) levels. The lipid profile assessment was done by measuring serum total 
cholesterol (TC), LDL cholesterol (LDL), triglycerides, HDL cholesterol (HDL), and VLDL 
levels. VLDL levels were determined using Freidwald’s formula (VLDL = TG/5). The HbA1c 
data was used to further categorize the diabetes patients into well-controlled diabetes (HbA1c 
≤ 7) and inadequately controlled diabetes groups (HbA1c ≥ 7) for further comparison of 
glycemic and lipid profiles. The data so obtained from the patients were compiled and 
statistically analyzed. 

Statistical analysis 

The data related to age, BMI, FBS, RBS, HbA1c, total cholesterol, LDL cholesterol, 
triglycerides, HDL cholesterol, and VLDL was parametric and has been expressed as mean ± 
standard deviation. The glycemic and lipid profile comparison amongst the two groups (well-
controlled diabetes group and inadequately controlled diabetes group) has been made using 
an independent student t-test. Linear regression analysis was used to check the correlations 
between the biochemical parameters in diabetes patients. P value < 0.05 has been considered 
significant. The statistical analysis was done using SPSS software (version 20). 

RESULTS 

The demographic data and glycemic and lipid profiles of diabetes patients have been shown 
in Table 1. In this study, it was found that the prevalence of type 2 diabetes mellitus was 
relatively higher in males in comparison to females. The mean age of the study subjects was 
54.9 years. The mean BMI of these patients was 30.3 falling in class 1 obese category. Out of 
191 diabetes patients, 100 (52%) also had hypertension. The nationality of these patients was 
Saudi. The diabetic patients showed a hyperglycemic and dyslipidemia blood picture (N=191, 
Table 1). Table 2 compares glycemic and lipid profiles amongst patients with adequately 
controlled diabetes and inadequately controlled diabetes. It was found that the patients whose 
HbA1c was > 7 had significantly higher FBS, RBS, HbA1c, total cholesterol, LDL cholesterol, 
triglycerides, and VLDL cholesterol level compared to diabetes patients with HbA1c ≤ 7. In 
Linear regression analysis (Table 3, Figure 1), the HbA1c groups of the diabetes patients 
showed a significant positive correlation with total cholesterol and LDL levels. Linear 
regression analysis (Table 3, Figure 2) also revealed that total cholesterol and triglyceride 
levels of diabetic patients showed a significant positive correlation with BMI.  

 

 

 



 
Riaz (Correlation between HbA1c and lipid profile in diabetes:  a health concern in Aseer, Saudi Arabia) 

 
 

 
Vol. 5, No. 2, 2023, pp. 60-68 63   10.26555/eshr.v5i2.6129 

  

Table 1. Demographic data, glycemic and lipid profile of diabetes patients (N=191) 

Demographic and biochemical variables Data 

Gender  
 

      Male 111(58%) 
      Female 80 (42%) 
Nationality Saudi 191 (100%) 
Age (years) (Mean ± SD) 54.9 ± 12.7  
BMI (Mean ± SD) 30.3 ± 5.6  
Blood pressure 

 

     Hypertensive (BP ≥140/90mmHg) 100 (52%) 
     Normotensive (BP < 130/85)  91 (48%)  

Glycemic and lipid profile parameters Mean ± SD 
     Fasting blood sugar (FBS)(mg/dl) 201.3 ± 69.8 
     Random blood sugar (RBS)(mg/dl) 313.9 ± 84.6 
     HbA1c (%) 10.3 ± 2.9 
     Total cholesterol (mg/dl) 210.4 ± 51.4 
     LDL (mg/dl) 121.7 ± 42.0 
     HDL (mg/dl) 33.9 ± 6.3 
     Triglycerides (mg/dl) 201.7 ± 120.3 
     VLDL (mg/dl) 40.3 ± 24.1 

 

Table 2. Comparison of glycemic and lipid profile amongst patients with adequately 
controlled diabetes and inadequately controlled diabetes. 

Variables 

Patients with 
adequately 
controlled diabetes 

Patients with 
inadequately 
controlled diabetes  p-value 

 (HbA1c ≤ 7) (HbA1c > 7)  
 (N=40) (N=151)  
 Mean ± SD Mean ± SD  
Fasting blood sugar (FBS) (mg/dl) 137.3 ± 29.1 218.3 ± 67.6 0.000* 
Random blood sugar (RBS) (mg/dl) 223.0 ± 36.9 337.9 ± 76.9 0.000* 
HbA1c (%) 6.5 ± 0.7 11.3 ± 2.4 0.000* 
Total cholesterol (TC)  (mg/dl) 184.4 ± 40.7 217.3 ± 51.9 0.000* 
LDL (mg/dl) 106.8 ± 15.8 125.6 ± 45.8 0.000* 
HDL (mg/dl) 33.2 ± 2.1 34.1 ± 6.8 0.39 
Triglyceride (mg/dl) 132.8 ± 85.4 216.8 ± 121.9 0.001* 
VLDL (mg/dl) 26.6 (17.1) 43.4 (24.4) 0.001* 

     *p value < 0.05 is considered significant 

 

 



 
Riaz (Correlation between HbA1c and lipid profile in diabetes:  a health concern in Aseer, Saudi Arabia) 

 
 

 
Vol. 5, No. 2, 2023, pp. 60-68 64   10.26555/eshr.v5i2.6129 

  

Table 3. Linear regression analysis to check the correlation between the biochemical 
parameters in diabetes patients 

Variables Correlation coefficient  
(Beta) 

p-value 

HbA1c and TC 0.3 0.001* 
HbA1c and LDL 0.3  0.000* 
HbA1c and triglyceride 0.2  0.053 
HbA1c and HDL 0.1  0.533 
HbA1c and VLDL 0.2  0.053 
Total cholesterol and BMI 0.2    0.037* 
Triglyceride and BMI 0.4  0.001* 

                   *p value < 0.05 is considered significant 

 

 

 
(a) 

 

 
(b) 

Figure 1. Correlation of HbA1c with total cholesterol (a) and HbA1c with LDL (b) 

DISCUSSION  

This study shows that type 2 diabetes mellitus was more prevalent in males, and the average 
age of the patients was 54.9 years. These patients were found to be falling in the obesity class 
1 category. These patients were of Saudi nationality. Saudi Arabian diet predominantly 
contains food items of non-vegetarian origin. The non-vegetarian diets are considered high in 
cholesterol and triacylglycerol content, which might have been a contributing factor to obesity. 
A study by Wang et al. has shown that meat consumption is associated with increased BMI 
and obesity.5 The study also found that 52% of diabetes patients also had hypertension. The 
glycemic profile of the study subjects (N = 191) showed the mean with a standard deviation of 
fasting blood glucose (201.3 ± 69.8), random blood glucose (313.9 ± 84.6, and HbA1c (10.3 



 
Riaz (Correlation between HbA1c and lipid profile in diabetes:  a health concern in Aseer, Saudi Arabia) 

 
 

 
Vol. 5, No. 2, 2023, pp. 60-68 65   10.26555/eshr.v5i2.6129 

  

± 2.9) were all out of the normal reference range indicating that these patients' despite of 
taking oral hypoglycemic drugs and insulin were not able to maintain an average glycemic 
profile. The lipid profile analysis also revealed that these patients had dyslipidemia. Their 
mean with a standard deviation of total cholesterol (210.4 ± 51.4), LDL cholesterol (121.7 ± 
42.0), triglycerides (201.7 ± 120.3), HDL cholesterol (33.9 ± 6.3), and VLDL (40.3 ± 24.1) were 
found to be out of normal reference range. According to the NCEP ATP III criteria, the total 
cholesterol level in the range of 200-239 is considered to be borderline high, LDL cholesterol 
in the range of 100-129 is considered above the optimal range, HDL cholesterol < 40 is 
considered to be low and fasting triglyceride level > 150 mg/dl is considered to be high. This 
study confirmed through linear regression analysis that HbA1c, a glycemic profile indicator, 
significantly correlated with total serum cholesterol and LDL cholesterol, indicating that 
hyperglycemia leads to dyslipidemia in diabetic patients.  

 

 
(a) 

 

 
(b) 

 

Figure 2. Correlation of total cholesterol with BMI (a) and triglycerides with BMI (b) 

The linear regression also confirmed that serum total cholesterol and triglyceride levels were 
significantly correlated with BMI, indicating that dyslipidemia leads to increased BMI. The 
mean BMI of the diabetic subjects enrolled in this study was found to be in the obesity 
category, implying that dyslipidemia could have led to obesity. A study in the literature has 
shown that approximately 60-70% of patients who are obese are dyslipidemia.6 Dyslipidemia 
and obesity7 are associated with increased risk for cardiovascular complications. Besides this, 
the presence of hypertension is also considered to be a risk factor for the development of 
cardiovascular disease.8 

The adequately controlled diabetic group and inadequately controlled diabetic group, when 
compared for their glycemic and dyslipidemia profile, showed a significantly deranged 
glycemic and dyslipidemia picture in the poorly controlled diabetic group (Table 2). This implies 
that if tight glycemic control is not maintained in diabetes patients, then the pathophysiology 
of diabetes progresses in an uncontrolled manner leading to the worsening of the lipid profile. 



 
Riaz (Correlation between HbA1c and lipid profile in diabetes:  a health concern in Aseer, Saudi Arabia) 

 
 

 
Vol. 5, No. 2, 2023, pp. 60-68 66   10.26555/eshr.v5i2.6129 

  

Dyslipidemia increases the risk for cardiovascular complications mainly because dyslipidemia 
promotes atherosclerosis. 9,10 High levels of low-density lipoprotein (LDL)11 and low levels of 
high-density lipoprotein (HDL)12 are associated with myocardial infarction (MI) and stroke.13,14 
A study by Tasneem et al. also found that HbA1c can be used as a marker for dyslipidemia 
and to screen patients with a high risk for cardiovascular complications.15 A study by Anderson 
et al. also showed that dyslipidemia is a strong predictor of cardiovascular disease.16 
Dyslipidemia causes endothelial damage17 and subsequent loss of physiological vasomotor 
activity that may manifest as increased blood pressure (BP).18,19 Many studies have 
recommended treating dyslipidemia to decrease the risk of cardiovascular diseases. 20,21 

Besides cardiovascular complications, hyperglycemia and dyslipidemia in diabetes are also 
found to be associated with other complications such as diabetic retinopathy, cataract, diabetic 
nephropathy, diabetic foot, urinary tract infections, skin infections, and xanthomas. Thus, it is 
of great concern to control diabetes by administering oral hypoglycemic drugs, insulin, and 
lifestyle modification and maintaining a regular follow-up of diabetic patients.22 It is our 
observation that diabetes patients are not very compliant in taking pharmacological treatment 
regularly, which might be a probable reason in our study that 151 out of 191 diabetes patients 
(79%) had inadequately controlled diabetes. Diabetic patients must be thoroughly counseled 
regarding the importance of taking drugs regularly in appropriate doses. Though drugs play 
an indispensable role in controlling the blood sugar level, the role of lifestyle modification 
should not be overlooked in type 2 diabetes mellitus.23 Since type 2 diabetes mellitus is 
characterized by insulin resistance, these patients must be counseled and encouraged by 
healthcare practitioners to adopt measures related to lifestyle modification, such as engaging 
in daily physical exercise to upregulate the peripheral insulin receptors on the cells to decrease 
the insulin resistance in the body which would eventually help in controlling the blood glucose 
levels.24 These patients must be explained about the medical complications associated with 
diabetes mellitus that they are likely to develop in the future. Besides this, the patients should 
be advised to consume a smaller number of meats, eggs, and oily foods to improve their lipid 
profile further and that they should avoid eating foods with high glycemic index and must 
include complex carbohydrate-rich foods and dietary fibers (salads) in their meals which would 
further decrease the absorption of cholesterol from intestine into the blood. The patients of 
T2DM must also be motivated to keep their body weight in control and self-monitor their blood 
pressure and blood glucose levels continuously by using user-friendly point-of-care testing 
devices such as digital BP apparatus and glucometers.25 Since studies conducted at a primary 
health care center in Saudi Arabia are minimal, our research data has substantial value in 
formulating health policies for the local population to ensure reasonable control over diabetes 
mellitus. 

CONCLUSION 

Type 2 diabetes mellitus patients presenting at the primary health care center of the Aseer 
region were found to be obese, with 52% of cases having concomitant hypertension. Despite 
taking oral hypoglycemic drugs and insulin, these patients showed a deranged glycemic and 
lipid profile. Patients of T2DM in the Aseer region of Saudi Arabia must be regularly followed 
up to review the ongoing drug therapy and its compliance so that glycemic and lipid profiles 
can be adequately controlled, given the impending risk of complications associated with 



 
Riaz (Correlation between HbA1c and lipid profile in diabetes:  a health concern in Aseer, Saudi Arabia) 

 
 

 
Vol. 5, No. 2, 2023, pp. 60-68 67   10.26555/eshr.v5i2.6129 

  

T2DM. The authors also recommend that thorough counseling of these patients regarding 
lifestyle management measures might be helpful. 

Acknowledgment 

The authors thank the nursing staff working at a primary health care center for assisting in 
data collection for this study. 

Declarations 

Authors' contribution 

FR designed the study, collected the data, and reviewed and edited the manuscript. AN 
statistically analyzed the data, prepared the result, and wrote the manuscript.  

Funding Statement 

 This research has not received external funding. 

Conflict of interest 

There is no conflict of interest in this research.  

REFERENCES 

1.  International Diabetes Federation. IDF Diabetes Atlas, 10th Edition. 2021.  
2.  Meo SA, Usmani AM, Qalbani E. Prevalence of type 2 diabetes in the Arab world: impact 

of GDP and energy consumption. Eur Rev Med Pharmacol Sci. 2017;21(6):1303–12.  
3.  Al Dawish M, Robert A, Braham R, Al Hayek A, Al Saeed A, Ahmed R, et al. Diabetes 

Mellitus in Saudi Arabia: A Review of the Recent Literature. Curr Diabetes Rev. 
2016;12(4):359–68.  

4.  Faselis C, Katsimardou A, Imprialos K, Deligkaris P, Kallistratos M, Dimitriadis K. 
Microvascular complications of Type 2 Diabetes mellitus. Curr Vasc Pharmacol. 
2020;18(2):117–24.  

5.  Wang Y, Beydoun M. Meat consumption is associated with obesity and central obesity 
among US adults. Int J Obes. 2009;33(6):621–8.  

6.  Bays HE, Toth PP, Kris-Etherton PM, Abate N, Aronne LJ, Brown WV, et al. Obesity, 
adiposity, and dyslipidemia: A consensus statement from the National Lipid Association. 
J Clin Lipidol. 2013;7(4):304–83.  

7.  Cercato C, Fonseca FA. Cardiovascular risk and obesity. Diabetol Metab Syndr. 
2019;11(1):1–15.  

8.  Fuchs FD, Whelton PK. High Blood Pressure and Cardiovascular Disease. Hypertension. 
2020;(Cvd):285–92.  

9.  Pedersen T, Kjekshus J, Berg K, Haghfelt T, Faergeman O, Faergeman G, et al. 
Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering 
in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival 
Study (4S). J Atheroscler. 1994;5(3):81–7.  

10.  Wong ND. Epidemiological studies of CHD and the evolution of preventive cardiology. 
Nat Rev Cardiol. 2014;11(5):276–89.  

11.  Berliner J, Navab M, Fogelman A, Frank J, Demer L, Edwards P, et al. Atherosclerosis: 
basic mechanisms oxidation, inflammation, and genetics. Circulation. 1995;91(9):2488–
96.  



 
Riaz (Correlation between HbA1c and lipid profile in diabetes:  a health concern in Aseer, Saudi Arabia) 

 
 

 
Vol. 5, No. 2, 2023, pp. 60-68 68   10.26555/eshr.v5i2.6129 

  

12.  Gordon T, Castelli W, Hjortland M, Kannel W, Dawber T. High density lipoprotein as a 
protective factor against coronary heart disease. The Framingham Study. Am J Med. 
1977;62(5):707–14.  

13.  Ference BA, Ginsberg HN, Graham I, Ray KK, Packard CJ, Bruckert E, et al. Low-density 
lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, 
epidemiologic, and clinical studies. A consensus statement fromthe European 
Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459–72.  

14.  Yaghi S, Elkind MSV. Lipids and Cerebrovascular Disease: Research and Practice. 
Stroke. 2015;46(11):3322–8.  

15.  Tasneem A, Vemuri H, Shaik M, Khan M. Correlation between Glycosylated Haemoglobin 
and Dyslipidaemia in Patients with Type 2 Diabetes Mellitus. Int J Health Sci (Qassim). 
2021;4(24):1–3.  

16.  Anderson KM. Cholesterol and mortality. 30 years of follow-up from the Framingham 
study. JAMA J Am Med Assoc. 1987;257(16):2176–80.  

17.  Nickenig G. Central role of the AT(1)-receptor in atherosclerosis. J Hum Hypertens. 
2002;16:26–33.  

18.  Nickenig G, Harrison D. Current Perspective The AT1 -Type Angiotensin Receptor in 
Oxidative Stress and Atherogenesis Part II: AT1 Receptor Regulation. Circulation. 
2002;530–6.  

19.  Nickenig G, Harrison D. Current Perspective Current Perspective The AT1 -Type 
Angiotensin Receptor in Oxidative Stress and Atherogenesis Part I: Oxidative Stress and 
Atherogenesis. Circulation. 2002;393–6.  

20.  Khavandi M, Duarte F, Ginsberg HN, Reyes-Soffer G. Treatment of Dyslipidemias to 
Prevent Cardiovascular Disease in Patients with Type 2 Diabetes. Curr Cardiol Rep. 
2017;19(1):1–16.  

21.  Dolzhenko M, Barnett O, Grassos C, Dragomiretska N, Goloborodko B, Ilashchuk T, et 
al. Management of Dyslipidemia in Individuals with Low-to-Moderate Cardiovascular Risk: 
Role of Nutraceuticals. Adv Ther. 2020;37(11):4549–67.  

22.  Papatheodorou K, Banach M, Bekiari E, Rizzo M, Edmonds M. Complications of Diabetes 
2017 Konstantinos. J Diabetes Res. 2018;2018, Arti:4.  

23.  Khaltaev N, Axelrod S. Global trends in diabetes-related mortality with regard to lifestyle 
modifications, risk factors, and affordable management: A preliminary analysis. Chronic 
Dis Transl Med. 2021;7(3):182–9.  

24.  Bird S, Hawley J. Update on the effects of physical activity on insulin sensitivity in humans. 
BMJ Open Sport Exerc Med. 2017;2(1):1–26.  

25.  Mellergård E, Johnsson P, Eek F. Developing a web-based support using self-affirmation 
to motivate lifestyle changes in type 2 diabetes: A qualitative study assessing patient 
perspectives on self-management and views on a digital lifestyle intervention. Internet 
Interv. 2021;24(March):100384.  

 


