Journal of Advances in Medical and Pharmaceutical Sciences

Volume 24, Issue 11, Page 1-8, 2022;Article no.JAMPS.975353ISSN: 2394-1111

GLYCOSYLATED HAEMOGLOBIN AND LIPID PROFILE PATTERN FOR

HYPERTENSIVE-DIABETICS IN PORT HARCOURT

*Tamuno-Opubo, Abiye1 Stanley, Rosemary Oluchi2 Bademosi Adetomi3 George Abiye 4 Austin-
Asomeji, Iyingiala3 Eyindah, Richard Chitusi1
1
Department of Human Physiology, College of Medical Sciences, Rivers State University, Rivers state,
Nigeria.
2
Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Rivers state, Nigeria.
3
Department of Community Medicine, College of Medical Sciences, Rivers State University, Rivers state,
Nigeria.
4
Department of Anaesthesiology, College of Medical Sciences, Rivers State University, Rivers state,
Nigeria.
*Corresponding author: [email protected]

ABSTRACT

Aim: The aim of this study is the assessment of the glycosylated haemoglobin (Hb1Ac) and lipid
profile patterns of hypertensive/diabetic patients in Port Harcourt.
Study Design: Cross-sectional study
Study Location and Period: Port Harcourt, Nigeria. July – December 2022.
Methods: The lipid profile and glycated haemoglobin (HBA1c) was assessed from venous blood
samples collected from 50 diabetic persons living with hypertension.
Results: It was observed that 26% of the subjects had good glycaemia control (HBA1c<7%), while
74% had poor glycaemia control (HBA1c >7%). The results also showed the elevated LDL was
significantly higher (p = 0.0004) among persons with poor glycaemia control (96.0%), compared
to persons with good glycaemia control (4.0%). The elevated triglyceride was significantly higher
(p = 0.0057) in persons with poor glycaemia control (95%) compared to person with good
glycaemia control (5.0%). The data also showed the proportion of persons with elevated total
cholesterol is significantly higher (p=0.024) in persons with poor glycemic control (88.0%)
compared to persons with good glycaemia control (12.0%).
Conclusion: This finding implies that, in addition to being a glycaemia control indicator, HbA1c
can be utilized as a predictor of dyslipidemia, cardiovascular diseases and stroke in
hypertensive/diabetics.

Keywords: Glycemic control, Diabetes, Hypertension, Dyslipidemia.

1. INTRODUCTION Type 2 and associated cardiovascular

Diabetes is impacting a growing number of consequences[3, 4]. The American Diabetes
individuals throughout the world, especially Association (ADA) recommends that most
in developing nations, and diabetes adults with diabetes achieve a glycated
complications are becoming more common hemoglobin (HbA1c) < 7.0%, BP < 140/90
among younger people[1, 2]. Major public mmHg, and low-density lipoprotein
health concerns globally include Diabetes cholesterol (LDL-C) < 100 mg/dL[5].
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 Journal of Advances in Medical and Pharmaceutical Sciences
Volume 24, Issue 11, Page 1-8, 2022;Article no.JAMPS.975353ISSN: 2394-1111

Despite evidence showing the benefits of are the leading causes of disability in low-
simultaneous control of HbA1c, BP, and and middle-income countries, accounting for
LDL-C in reducing the risk of diabetes more than 87 per cent of all disabilities[10,
complications and death studies from 11]. There is additional evidence that
Western, Asian and African countries prediabetes (a metabolic condition
showed that attainment of all three goals intermediate between normoglycemia and
simultaneously was low (10–30%)[6, 7]. The Type 2 diabetes) is linked to a higher risk of
risk of coronary artery disease (CAD), the heart disease[3, 12]. The aim of this study
primary cause of mortality in persons with was to assess the glycosylated haemoglobin
Type 2 diabetes, is raised by two to four times (Hb1Ac) and lipid profile patterns of
in people with Type 2 diabetes[5, 8, 9]. As a diabetics living with hypertension in Port
result of dyslipidemia and hypertension, Harcourt, Rivers state.
diabetes and coronary artery disease (CAD)
2. METHODS ͌49 (minimum sample size)
2.1 Study Area This was rounded off to 50 subjects in this
This research was specifically carried out in study.
the medical outpatient clinic (MOPC) of the The total number of subjects used for this
internal medicine department of the Rivers study included about 50
State University Teaching Hospital, which hypertensive/diabetics people who were
was formerly known as Braithwaite selected using simple random sampling
Memorial Specialist Hospital (BMSH). technique. This included 22 males and 28
2.2 Study Design females who are hypertensive/ diabetics. The
This study utilized a cross-sectional research subjects selected were known
design. Participants were selected randomly hypertensive/diabetics subjects that have
from the medical outpatient clinic (MOPC) been attending the medical outpatient clinic
of Rivers State University Teaching Hospital. (MOPC) in the Rivers State University
Teaching Hospital.
2.3 Study Sample 2.4 Data Collection
The study population was made up of Information on the demographic data, the
hypertensive/diabetic volunteers who came lipid profile and glycated haemoglobin
to the medical outpatient clinic during the (HBA1c) were collected from the clinical
study period, which was December 2021 to records of the participants using a
February 2022. standardized PROFORMA data collection
The sample size was calculated using the sheet.
Leslie Fischer’s formula 2.5 Ethical Consideration
2
(𝑍𝑎+𝑍𝛽)2 (𝑃𝑜(1−𝑃𝑜)+𝑃1 (1−𝑃1 )) Ethical approval was sought from the ethics
N= (𝑃1 −𝑃𝑜)2 committee of the Rivers State University and
Where Rivers State University Teaching Hospital.
N = required minimum of sample size 2.6 Data Analysis
Zα = % of normal distribution The data was described using summary
corresponding to the required significant statistics (frequency, percentage, mean and
level of 5 % = 1.96 standard error of mean) as appropriate. The
Zβ = point of normal distribution average lipid parameters were compared with
corresponding to the statistical power of the independent t-test statistic. Pearson’s
80% = 0.842 correlation was used to assess the association
P1 = expected response of the lipid parameters and HBA1c among
(1.96+0.842)2 (0.80(1−0.80)+0.90(1−0.90))2
n= the participants. The distribution of
(0.90−0.8)2
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 Journal of Advances in Medical and Pharmaceutical Sciences
Volume 24, Issue 11, Page 1-8, 2022;Article no.JAMPS.975353ISSN: 2394-1111

dyslipidaemia by glycated haemoglobin was interval and a p-value less than 0.05 was
assessed using the Chi-square statistic. All considered statistically significant.
analysis was done at a 95% confidence
3. RESULTS
The gender distribution of the participants in this study showed that 22 were male and 28 were
female as shown in figure 1.

Males Females

22, 44.0%
28, 56.0%

Figure 1: Gender Distribution of Participants

The data presented in table 2. Represent the serum lipid profile of hypertensive/diabetics attending
the medical outpatient clinic in the Rivers State University Teaching Hospital in Port Harcourt.
The mean value of the Total Cholesterol in male and female of the study population were
4.62±0.08 mmol/L and 5.11±0.0608 mmol/L respectively. The Total Cholesterol in female is
significantly higher than the total cholesterol in male population at p<0.00. However, the mean
value of the Triglycerides in male and female of the study population were 0.90±0.04 mmol/L and
1.17±0.08 mmol/L respectively. The Triglyceride in female is significantly higher than the total
cholesterol in male population at p<0.005. The mean value of the High density-lipoprotein
Cholesterol in male and female of the study population were 0.89±0.04 mmol/L and 1.00±0.02
mmol/L respectively. The High density-lipoprotein Cholesterol in female is significantly higher
than the High density-lipoprotein Cholesterol in male population at p<0.01. However, the mean
value of the Low density-lipoprotein Cholesterol in male and female of the study population were
3.25±0.08 mmol/L and 3.53±0.07 mmol/L. The Low density-lipoprotein Cholesterol in female is
significantly higher than the High density-lipoprotein Cholesterol in male population at p<0.006.
Table 2: Lipid Profile by Gender
Parameters Male Female T-test (p- value)
Total Cholesterol (mmol/L) 4.62±0.08 5.11±0.06 <0.001*
Triglycerides (mmol/L) 0.90±0.04 1.17±0.08 0.005*
HDL (mmol/L) 0.89±0.04 1.00±0.02 0.01*
LDL (mmol/L) 3.25±0.08 3.53±0.07 0.006*
All values are presented in Mean ± SEM
LDL: Low density lipoprotein, HDL: High density lipoprotein SEM: Standard error of Mean
Figure 2 shows that the mean value of the Glycosylated Haemoglobin in male and female of the
study population were 7.43±0.36 mmol/L and 8.44±0.42 mmol/L. The Glycosylated Haemoglobin

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Volume 24, Issue 11, Page 1-8, 2022;Article no.JAMPS.975353ISSN: 2394-1111

in female is significantly higher than the High density-lipoprotein Cholesterol in male population
at p<0.04.
10

0
Male Female

Fig 2. Showing the male to female comparison of the glycosylated haemoglobin of hypertensive
diabetic subjects.
Table 4 shows the correlation of lipid indices and HBA1c among the study subjects.
Table 4: Correlation Analysis between Serum Lipid Profile and HbA1c
Parameters HBA1c p-value
TC 0.30 <0.001
TG 0.16 <0.001
LDL 0.38 <0.001
HDL 0.09 <0.001

Figure 3 shows the distribution of glycaemia control among the subjects. The figure shows that
26% of the subjects had good glycaemia control (HBA1c<7%), while 74% had poor glycaemia
control (HBA1c >7%).

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Volume 24, Issue 11, Page 1-8, 2022;Article no.JAMPS.975353ISSN: 2394-1111

Hb1Ac >7% HbA1c <7%

13, 26%

37, 74%

Figure 3: Distribution of HBA1c in study subjects

The table showed the elevated LDL was significantly higher (p = 0.0004) among persons with
poor glycaemia control (96.0%), compared to persons with good glycaemia control (4.0%). The
elevated triglyceride was significantly higher (p = 0.0057) in persons with poor glycaemia control
(95%) compared to person with good glycaemia control (5.0%). The data also showed the
proportion of persons with elevated total cholesterol is significantly higher (p=0.024) in persons
with poor glycemic control (88.0%) compared to persons with good glycaemia control (12.0%).
Table 5: Association of Lipid profile and HBA1c among study participants
Hb1Ac >7% HbA1c <7% Total Chi-square
Lipid Profile n, (%) n, (%) n, (%) (p-value)
LDL
Elevated 24(96.0) 1(4.0) 25(100.0) 12.58
Normal 13(52.0) 12(48.0) 25(100.0) (0.0004)*
HDL
Elevated 16(88.9) 2(11.1) 18(100.0) 3.24
Normal 21(65.6) 11(34.4) 32(100.0) (0.0718)
Triglyceride
Elevated 19(95.0) 1(5.0) 20(100.0) 7.64
Normal 18(60.0) 12(40.0) 30(100.0) (0.0057)*
Total cholesterol
Elevated 22(88.0) 3(12.0) 25(100.0) 5.09
Normal 15(60.0) 10(40.0) 25(100.0) (0.024)*
*Statistically significant (p<0.05)
4. DISCUSSION HDL levels. Although there were substantial
In this study, the pattern of lipid profile differences between male and female
parameters in hypertensive/diabetic hypertensive/diabetic individuals, females
participants as well as their relationship with have significantly higher total cholesterol and
HbA1c was investigated. This study low density lipoprotein levels than males.
hypertensive/diabetic dyslipidemia which is This finding is in agreement with the
characterized by high triglyceride and low previous study done by Hussain et al,[13]. In
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Volume 24, Issue 11, Page 1-8, 2022;Article no.JAMPS.975353ISSN: 2394-1111

this study, there was a strong link between triglycerides, HbA1c can be utilized as a
HbA1c and lipid profile which is consistent powerful marker for dyslipidemia and can
with earlier research was discovered[6, 7]. help prevent macro- and micro-vascular
HbA1c and TC, LDL, and HDL all had problems [16].
substantial associations. HbA1c levels have
been linked to TC, LDL, and TG in diabetes The levels of glycosylated hemoglobin
individuals in several investigations[13]. (HbA1c) and the lipid profile were shown to
HDL measurement is simple and can be done be significantly correlated in this
even when patients are not fasting. It can also investigation. This could assist anticipate
be done regardless of TG concentration. As a lipid profile values based on glycemic
result, HDL cholesterol can be quite useful in control, and hence identify people at risk of
identifying dyslipidemia in diabetics. In our diabetic complications[17, 18]. Lipid
investigation, the risk ratio had the highest abnormalities are common in
connection with HbA1c. According to the hypertensive/diabetic patients, and type-2
study by Prila et al., found that the main lipid diabetes mellitus patients are particularly
predictor of vascular events was mean vulnerable. Insulin resistance, which leads to
TC/HDL-C ratio with a hazard ratio (HR) of increased release of free fatty acids from fatty
1.46 in a prospective cohort study with 418 tissue, impaired insulin dependent muscle
Type 2 diabetic adults and follow-up until the uptake of free fatty acids, and increased fatty
manifestation of a cardiovascular event[14]. acid release to the hepatic tissue, is said to be
The predictive ability of the TC/HDL ratio related to the abnormal lipid profile observed
was shown to be higher than that of HDL in type 2 diabetes mellitus, as reported in
cholesterol in the same study, and the previous studies[3, 6, 19, 20].
researchers concluded that TC/HDL-C might CONCLUSION
be utilized as a therapy guide for diabetic In conclusion, HbA1c exhibited a favorable
dyslipidemia [1, 13]. In the current study, correlation with serum total cholesterol and
hypertensive/diabetic individuals were LDL, but a negative correlation with HDL in
separated into two groups based on HbA1c mostly the male more than the females that
cut-off of 7.0 percent in this study. In are hypertensive/diabetics. This data imply
comparison to hypertensive/diabetic patients that, in addition to being a glycaemic control
with HbA1c of less than 7.0 percent, indicator, HbA1c can be utilized as a
hypertensive/diabetic patients with HbA1c of predictor of dyslipidemia in
more than 7.0 percent had a substantial rise in hypertensive/diabetics. As a result, HbA1c
TC, TG, LDL, and no significant change in could be used to screen diabetes with or
HDL. This is consistent with the findings of without hypertension patients for the risk of
similar studies indicating that patients with a cardiovascular events, as well as to prompt
higher HbA1c score have more severe lipid-lowering medication treatment.
dyslipidemia. Because raised HbA1c and REFFERENCES
dyslipidemia are independent risk factors for [1] Rosenblit PD. Common medications
cardiovascular disease (CVD), diabetic used by patients with type 2 diabetes
patients with elevated HbA1c and mellitus: what are their effects on the
dyslipidemia might be regarded a CVD high- lipid profile? Cardiovasc Diabetol
risk group[5–7]. In diabetics, improving 2016 151 2016; 15: 1–13.
glycemic control can significantly lower the [2] Kumar SP, Sandhya AM. A study on
risk of cardiovascular events [12, 15]. the glycemic, lipid and blood pressure
According to Parveen et al., who discovered control among the type 2 diabetes
a strong link between HbA1c and high patients of north Kerala, India. Indian
6
 Journal of Advances in Medical and Pharmaceutical Sciences
Volume 24, Issue 11, Page 1-8, 2022;Article no.JAMPS.975353ISSN: 2394-1111

Heart J 2018; 70: 482–485. low-resource setting. Pan Afr Med J;

[3] Lewington S, Lacey B, Clarke R, et 41. Epub ahead of print 1 January
al. The burden of hypertension and 2022. DOI:
associated risk for cardiovascular 10.11604/PAMJ.2022.41.281.33802.
mortality in China. JAMA Intern Med [10] Antwi-Baffour S, Kyeremeh R,
2016; 176: 524–532. Boateng SO, et al. Haematological
[4] Saeedi P, Petersohn I, Salpea P, et al. parameters and lipid profile
Global and regional diabetes abnormalities among patients with
prevalence estimates for 2019 and Type-2 diabetes mellitus in Ghana.
projections for 2030 and 2045: Lipids Health Dis; 17. Epub ahead of
Results from the International print 13 December 2018. DOI:
Diabetes Federation Diabetes Atlas, 10.1186/S12944-018-0926-Y.
9th edition. Diabetes Res Clin Pract; [11] Kaur R, Kaur M, Singh J. Endothelial
157. Epub ahead of print 1 November dysfunction and platelet hyperactivity
2019. DOI: in type 2 diabetes mellitus: Molecular
10.1016/J.DIABRES.2019.107843. insights and therapeutic strategies.
[5] Al-Shaheeb S, Hashim HK, Cardiovasc Diabetol; 17. Epub ahead
Mohammed AK, et al. Assessment of of print 31 August 2018. DOI:
lipid profile with HbA1c in type 2 10.1186/S12933-018-0763-3.
diabetic Iraqi patients. Bionatura; 7. [12] Arkew M, Yemane T, Mengistu Y, et
Epub ahead of print 2022. DOI: al. Hematological parameters of type
10.21931/RB/2022.07.03.29. 2 diabetic adult patients at Debre
[6] Quah JHM, Liu YP, Luo N, et al. Berhan Referral Hospital, Northeast
Younger adult type 2 diabetic patients Ethiopia: A comparative cross-
have poorer glycaemic control: A sectional study. PLoS One; 16. Epub
cross-sectional study in a primary ahead of print 1 June 2021. DOI:
care setting in Singapore. BMC 10.1371/JOURNAL.PONE.0253286.
Endocr Disord; 13. Epub ahead of [13] Hussain A, Ali I, Ijaz M, et al.
print 3 June 2013. DOI: Correlation between hemoglobin A1c
10.1186/1472-6823-13-18. and serum lipid profile in Afghani
[7] Hu H, Hori A, Nishiura C, et al. patients with type 2 diabetes:
Hba1c, Blood Pressure, and Lipid hemoglobin A1c prognosticates
Control in People with Diabetes: dyslipidemia. Ther Adv Endocrinol
Japan Epidemiology Collaboration on Metab 2017; 8: 51–57.
Occupational Health Study. PLoS [14] Pilla R, Palleti SK, Rayala R, et al.
One; 11. Epub ahead of print 1 July Glycated Haemoglobin (HbA1c)
2016. DOI: Variations in Nondiabetics With
10.1371/JOURNAL.PONE.0159071. Nutritional Anemia. Cureus; 12. Epub
[8] Huang X, Qin C, Guo X, et al. ahead of print 14 November 2020.
Association of hemoglobin A1c with DOI: 10.7759/CUREUS.11479.
the incidence of hypertension: A large [15] Milosevic D, Panin VL. Relationship
prospective study. Front Endocrinol between hematological parameters
(Lausanne) 2023; 13: 3578. and glycemic control in type 2
[9] Nnakenyi ID, Nnakenyi EF, Parker diabetes mellitus patients. J Med
EJ, et al. Relationship between Biochem 2019; 38: 164–171.
glycaemic control and lipid profile in [16] Parveen K, Siddiqui WA, Kausar A,
type 2 diabetes mellitus patients in a et al. Diabetic Nephropathy-a Major
7
 Journal of Advances in Medical and Pharmaceutical Sciences
Volume 24, Issue 11, Page 1-8, 2022;Article no.JAMPS.975353ISSN: 2394-1111

Macrovascular Complication. 18: 785–802.

Available online www.ijpras.com Int [19] Aryal N, Weatherall M, Bhatta YKD,
J Pharm Res Allied Sci 2016; 5: 132– et al. Lipid Profiles, Glycated
158. Hemoglobin, and Diabetes in People
[17] Mesas AE, Garrido-Miguel M, Living at High Altitude in Nepal. Int
Fernández-Rodríguez R, et al. The J Environ Res Public Health; 14.
association of egg consumption with Epub ahead of print 10 September
blood pressure levels and glycated 2017. DOI:
hemoglobin in Spanish adults 10.3390/IJERPH14091041.
according to body mass index. Sci [20] Okumiya K, Sakamoto R, Ishimoto
Reports 2022 121 2022; 12: 1–9. Y, et al. Glucose intolerance
[18] Zhou B, Perel P, Mensah GA, et al. associated with hypoxia in people
Global epidemiology, health burden living at high altitudes in the Tibetan
and effective interventions for highland. BMJ Open; 6. Epub ahead
elevated blood pressure and of print 2016. DOI:
hypertension. Nat Rev Cardiol 2021; 10.1136/BMJOPEN-2015-009728.