136 J I M D C   2 0 1 8  136 

Open Access 
F u l l  L e n g t h  A r t i c l e  

Prevalence of Dyslipidemia among Diabetic Patients 

 in a Tertiary Care Hospital  

Muhammad Rehan1, Saman Waqar2, Haroon Khan3
 

1 House Physician, Pakistan Institute of Medical Sciences, Islamabad. 
2 Assistant Professor, Department of Chemical Pathology, Federal Medical and Dental College Islamabad. 

3 Professor, Department of Chemical Pathology, Rawal Institute of Health Sciences, Islamabad
  

A B S T R A C T  

Objective: To identify the frequency of dyslipidemia in diabetic patients. 

Patients and Methods: A cross sectional study was conducted among the patients visiting Pathology laboratory in 

Pakistan Institute of Medical Sciences (PIMS). After taking informed consent from the patients, a brief history was taken 

from the patients with the help of a questionnaire. Lipid profiles for these patients were analyzed using the same 

samples as of HbA1c to determine diabetic dyslipidemia. 

Results: A total number of 206 diabetic patients were inducted in this study. Out of the total sample, 179 (72.7%) 

respondents were on anti-diabetic therapy alone. About 31 (17.3%) were on antihypertensive therapy along with anti-

diabetic therapy. Only 36 (20.1%) patients were on lipid lowering medication along with anti-diabetic and anti-

hypertensive treatment. Dyslipidemia was more common in patients that were only on anti-diabetic therapy. 

Conclusion: Annual screening for dyslipidemia and management were not practiced according to guidelines for diabetic 

patients. Combination therapy comprising anti-diabetic and anti-dyslipidemia medications should be considered by 

clinicians instead focusing only on diabetes. 

Key words: Diabetes mellitus, Dyslipidemia, Lipid profile, Treatment. 

Author`s Contribution 
1 Conception, synthesis, planning of research 
and manuscript writing Interpretation and 
discussion 
2 Data analysis, interpretation and 
manuscript writing, 3 Active participation in 
data collection. 

Address of Correspondence 

Saman Waqar 
Email: samanwaqar@yahoo.com 

Article info. 

Received:  September 10, 2017 
Accepted:  April 24, 2018 

Cite this article. Rehan M, Waqar S, Khan H. Prevalence of Dyslipidemia and Assessment of 
Treatment Regimens among Diabetic Patients in a Tertiary Care Hospital. JIMDC.2018; 
7(2):136-139 

Funding Source: Nil 
Conflict of Interest: Nil 

I n t r o d u c t i o n  
 

In year 2014 global  prevalence for Diabetes was 

estimated to be 9% in young adults.1 About 1.5 million 

deaths in year 2012 were directly because of Diabetes.2  

The relationship between Diabetes, diabetic dyslipidemia 

and Cardio Vascular Diseases(CVS) has been 

established long ago. Vascular diseases have a major 

share in lowering quality of life and death.3 A number of 

risk factors have been determined for coronary artery and 

cardiovascular diseases, among these deranged lipid 

profiles are a major contributor to the  development of 

coronary artery disease.4 Lipoproteins increase is 

associated with significant risk of atherosclerosis.5 Globaly 

dyslipidemia results in 4 million deaths per annum.6 

Dyslipidemia means the derangement in body lipid levels, 

but most of the time dyslipidemia presents as 

hyperlipidemia. Hyperlipidemia may be due to 

hyperlipoprotinemia i.e. Increased levels of Low Density 

Lipoprotein (LDL), hypercholesterolemia or as 

hypertriglyceridemia or may be all combined. These were 

defined according to Fredrickson Classification.7 But 

dyslipidemia may present as hypolipidemia i.e. low levels 

of High Density Lipoproteins (HDL).8 A number of risk  

O R I G I N A L  A R T I C L E  



 

                           137 J I M D C   2 0 1 8  137 

factors has been identified that leads to dearrangements 

in body lipids. These include lifestyle, obesity, high insulin 

and a number of other genetic and environmental factors.  

In present situation clinicians are focusing more on 

diagnosis and treatment of diabetes only. Dyslipidemia 

associated with this condition is usually given lesser 

attention by the clinicians. Lipid profiles are not done 

frequently for diabetic patients. In this study we planned 

to identify the frequency of dyslipidemia in diabetic 

patients and to know if the population is taking only anti 

diabetic treatment or a combination with lipid lowering 

drugs. 

P a t i e n t s  a n d  M e t h o d s  

A cross sectional survey was conducted among the 

patients visiting Pathology laboratory in Pakistan Institute 

of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto 

Medical University (SZAMBU), Islamabad from May, 2016 

to July, 2016 by convenient sampling technique. A study 

sample of 222 patients was obtained using WHO 

calculator taking prevalence 17.5%, confidence level 95% 

and absolute precision of 5%.9 A total 250 diabetic 

patients were inducted in the study. Out of 250, total 4 

patients lost the study follow up and were excluded.  

After induction, patients were divided into three groups. 

Group 1 comprised of patients only on antidiabetic 

therapy. Group 2 comprised of patients receiving 

antihypertensive therapy along with antidiabetic 

medications. Group 3 included patients on lipid lowering 

medication along with antidiabetic and antihypertensive 

therapy. Group 1 Patients were further divided into three 

sub-groups on the basis of their HbA1c levels. Group 1a 

comprised of good glycemic control with normal HbA1c 

levels (HbA1c ≤6.5%), group 1b included patients with 

average glycemic control (HbA1c 6.6-9%) and group 1c 

with poor glycemic control (HbA1c > 9%). All subgroups  

of Group 1 were then considered for lipid profile 

evaluation. Dyslipidemia was defined according to the 

National Cholesterol Education Program Adult Treatment 

Panel (ATP) III. Presence of dyslipidemia was identified 

when LDL ≥ 130mg/dl, HDL <40 mg/dl, TC ≥200 mg/dl 

and triglycerides were ≥150 mg/dl. 

After taking informed consent from the patients, a brief 

history including drug details was taken with the help of a 

questionnaire. Total 3 ml fasting blood sample was taken 

to analyze HbA1c levels. By using the same fasting 

samples lipid profile was also calculated to determine 

diabetic dyslipidemia. Patients with deranged lipid profiles 

were identified and their drug therapy was assessed 

according to the history. Patients were followed by their 

phone numbers. Nominal data was collected and 

analyzed using SPSS version 20.  

R e s u l t s  

Total number of 246 participants included this study. 

Mean age of the respondents was 57.5 ± 15.2 years. 

Mean HbA1c value was 8.7 ± 2.5 %. Male patients were 

132 (53.6%) and females were 114 (46.3%). Out of 246 

diabetic patients, total 179 (72.7%) respondents were in 

group 1 (anti diabetic therapy alone), 31 were in group 2 

(anti diabetic + anti-hypertensive therapy) and 36 were in 

group 3 (anti diabetic+ anti-hypertensive +lipid lowering 

medications). After further sub division of group 1, total 82 

(45.8%) patients were in group 1a (good glycemic 

control), 53 (29.6%) were in group 1b (average glycemic 

control) and 44 (24.5%) patients were in group 1c (poor 

glycemic control) (Figure 1).  

 
Figure 1: Comparison of glycemic control in patients 
only on anti-diabetic therapy (n=179) 
 

In group 1, regarding lipid profile, HDL levels were 

deranged in large number of participants (70.3%). 

Prevalence of other lipid parameters with percentage 

derangements is shown in (Table 1).  

Family history for diabetes and hypertension was found 

positive among 65 (36.3%) of the respondents. Only 48 

(26.8%) had their lipid profile done in the past one year.  



 

                           138 J I M D C   2 0 1 8  138 

Lipid parameters were maximally deranged in patients 

having poorly controlled diabetes (Table 2). 

D i s c u s s i o n  

This study was conducted to evaluate the prevalence of 

dyslipidemia in our population along with treatment 

regimens for diabetic patients. The study concluded that 

most of the population is unaware of association between 

Diabetes with dyslipidemia. Only a small population had 

lipid lowering drugs prescribed along with anti-diabetic 

therapy (20.1%). Only anti-diabetic regimen was also 

observed among people of Czech Republic.10 

Dyslipidemia screening practices were not adequate in 

diabetic patients of our study (26.8%). Annual screening 

of diabetics by lipid profiles is the recommended 

guidelines by American Association of Clinical 

Endocrinologists (AACE). 11 

Contrary to this monotherapy approach was prevalent in 

our population. Combination regimens to control 

dyslipidemia was found in very few. A statin should be  

prescribed to a patient of age greater than 40 years with 

diagnosed diabetes.12  Stone et. al. in their guidelines also 

highlighted the use of statin therapy in a patient with 

diabetes and age 40 to 75 years or the LDL > 190 

mg/dl.13 More than 50% of our population had 

uncontrolled Diabetes Mellitus. This is a factor that 

contributes to increased number of complications 

including vascular diseases and atherosclerosis.14 In our 

neighboring country the percentage of uncontrolled 

diabetes exceeds 80% and due to uncontrolled diabetes, 

lipids are more deranged in Indian population.15 TC and 

TGs values of our population (22.9% and 40.7%) were 

more than Chinese population data (16.4% and 7.6%). 16 

Values of these parameters were less when compared to 

Turkish population.17 LDL values for our population was 

far less than Turkish population17 (13.4% versus 36.2%). 

Surprisingly HDL levels of our population were 

significantly reduced (in about 70%). These values did not 

coincide with any of other populations viewed in literature. 

C o n c l u s i o n  

Annual screening for dyslipidemia and management was 

not practiced according to guidelines among diabetic 

patients. Combination therapy comprising anti-diabetic 

and anti-dyslipidemia medications should be considered 

by clinicians instead focusing only on diabetes. Low levels 

of HDL require special attention. Further studies are 

required with large sample size and multi-center surveys 

to identify the causes of such low HDL prevalence among 

our population. 

R e f e r e n c e s  

1. Global status report on non-communicable diseases 2014. 
Geneva, World Health Organization, 2012. 

2. World Health Organization. Global Health Estimates: Deaths 
by Cause, Age, Sex and Country, 2000-2012. Geneva, WHO, 
2014. 

3. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, 
Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard 
VJ, et al. Heart disease and stroke statistics--2015 update: a 
report from the American Heart Association. Circulation. 
2015;131:e29–322. 

4. R C Turner,  H Millns, H A W Neil, I M Stratton,  S E Manley, 
D R Matthews, R R Holman, Risk factors for coronary artery 
disease in non-insulin dependent diabetes mellitus: United 
Kingdom prospective diabetes study (UKPDS: 23). BMJ 1998; 
316:823. 

5. Nicholls S, Lundman P. The emerging role of lipopro-teins in 
atherogenesis: beyond LDL cholesterol. Semin Vasc Med. 
2004; 4:187-195. 

6. Quantifying selected major risks to health. In: The World 
Health Report 2002—Reducing Risks, Promoting Healthy 

Table 1: Deranged lipid parameters in patients 
only on anti-diabetic therapy (n=179) 

Lipid Parameters n(%) 

Low density lipoprotein (LDL-C) 24 (13.4) 

Total Cholesterol 41 (22.9) 

Triglycerides 73 (40.7) 

High density lipoprotein (HDL-C) 126 (70.3) 

Table 2: Lipid Profile according to HbA1c values (n=179) 

HbA1c values 
(%) 

LDL 
n (%) 

Cholesterol 
n (%) 

Triglycerides 
n (%) 

HDL 
n (%) 

≤ 6.5 2 (1.1) 5 (2.79) 9 (5.02) 32 (17.87) 

6.6 – 9 7 (3.91) 7 (3.91) 21 (11.73) 27 (15.08) 

> 9 15 (8.37) 29 (16.2) 43 (24) 67 (37.43) 



 

                           139 J I M D C   2 0 1 8  139 

Life. Chapter 4: Geneva: World Health Organization; 2002:47-
97. 

7. Fredrickson DS, Lees RS. A system for phenotyping 
hyperlipoproteinemia. Circulation 1965;31:321-327. 

8. Ronald M. Lipid and lipoproteins in type 2 diabe-tes. Diabetes 
Care. 2004;27:1496-504 

9. Sarfraz M, Sajid S, Ashraf MA. Prevalence and pattern of 
dyslipidemia in hyperglycemic patients and its associated 
factors among Pakistani population. Saudi J Biol Sci 
2016;23:761-6.   

10. Šnejdrlová M, Češka R, Janíčková-Žďárská D, Honěk P, 
Dušek P, Pavlík T, Kvapil M. Hypolipidemic and 
antihypertensive therapy in diabetic patients in the Czech 
Republic: notes on the VZP (General Health Insurance 
Company) Data. Vnitr Lek. 2015; 61(11 Suppl 3):3S30-7. 

11. Jellinger P, Smith D, Mehta A, Ganda O, Handelsman Y, 
Rodbard H, Shepherd M, Seibel J. American Association of 
Clinical Endocrinologists' guidelines for management of 
dyslipidemia and prevention of atherosclerosis. Endocrine 
practice. 2012. 

12. Walker BR, Colledge NR. Davidson's principles and practice 
of medicine. Elsevier Health Sciences; 2013. 

13. Stone NJ, Robinson JG, Lichtenstein AH, Merz CN, Blum CB, 
Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, 

McBride P. 2013 ACC/AHA guideline on the treatment of 
blood cholesterol to reduce atherosclerotic cardiovascular risk 
in adults: a report of the American College of 
Cardiology/American Heart Association Task Force on 
Practice Guidelines. Journal of the American College of 
Cardiology. 2014; 63(25_PA):2889-934. 

14. Shera A, Jawad F. Prevalence of chronic complications and 
associated factors in Type 2 Diabe-tes. J Pak Med Assoc 
2004; 54:54-9. 

15. Pandya H, Lakhani JD, Dadhania J, Trivedi A. The 
prevalence and pattern of dyslipidemia among type 2 diabetic 
patients at rural based hospital in Gujarat, India. Indian J Clin 
Pract. 2012;22(12):36-44. 

16. Sun GZ, Li Z, Guo L, Zhou Y, Yang HM, Sun YX. High 
prevalence of dyslipidemia and associated risk factors among 
rural Chinese adults. Lipids in health and disease. 2014; 
13(1):1. 

17. Bayram F, Kocer D, Gundogan K, Kaya A, Demir O, Coskun 
R, Sabuncu T, Karaman A, Cesur M, Rizzo M, Toth PP. 
Prevalence of dyslipidemia and associated risk factors in 
Turkish adults. Journal of clinical lipidology. 2014; 8(2):206-
16.