The relationship between macrovascular and microvascular complications with fasting and postprandial triglyceride levels in diabetic patients

Aim: Dyslipidemia with hypertriglyceridemia is frequently seen in diabetic patients. Adults are fed every 4-6 hours and blood lipid levels are observed as postprandial for 16-18 hours of a day. The vascular effects of fasting triglyceride levels are well known moreover recent studies emphasize postprandial triglyceride levels may be more important than fasting levels. In this study, the relationship between macrovascular and microvascular complications in diabetic patients with fasting and postprandial triglyceride levels were investigated. Material and Methods: Sixty-one patients who were followed up or admitted to Cukurova University Faculty Of Medicine Endocrinology Department (31 men, 30 women) diagnosed with Diabetes Mellitus, were included in this study. A diet containing 60% fat and 825 kcal was prepared to the patients after 12 hours fasting. Blood samples were taken for fasting glucose, HbA1c levels, AST, ALT, Na, K, BUN, creatine, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides levels. After breakfast 2nd and 4th hour blood samples were taken in order to evaluate postprandial total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides levels. Height, weight, physical examination and anamnesis information's were recorded. Micro and macrovascular complications are also recorded. Findings: Sixty-one patients were included to this study. The comorbidities were respectively; 30 (49.6%) has hypertension, 13 (21.3%) coronary arterial disease, 57 (93.49%) diabetic neuropathy, 49 (80.3%) diabetic nephropathy, 51 (83.6%) diabetic retinopathy, 12 (19.7%) history of diabetic foot and 2 of the patients (3.3%) were diagnosed with peripheral arterial disease. Increase of 4th hour postprandial triglycerides levels were considered statistically significant (p<0.05) when fasting and postprandial triglyceride levels were compared in diabetic patients diagnosed with microvascular complications. The increase were also detected in diabetic patients diagnosed with macrovascular complications nevertheless but it was not considered statistically significant (p>0.05). Increase of 4th hour postprandial triglycerides levels were considered statistically significant in both women and men (p<0.05) when fasting and postprandial triglyceride levels were compared. However, there was no difference between genders. Both fasting and postprandial triglyceride levels were found higher in smokers. Moreover, as HbA1c levels were increased, fasting and postprandial triglyceride levels were shown to be increased and increase of 4th hour postprandial levels were found to be statistically significant. Results: The statististically increase of triglyceride levels in diabetic patients with microvascular complications may mask the postprandial values of triglyceride levels due to unknown levels of postprandial triglyceride levels in untreated patients because of normal triglyceride levels. Thus, we suggest standard and easily applied triglyceride test must be determined, 4th hour triglyceride levels must be measured and new reference values must be established especially in diabetic patients with normal fasting triglyceride levels. Nontheless, this consideration must be evaluated in larger patient groups because in our study there was few diabetic patients with macrovascular complication. Key Words: Diabetes mellitus, microvascular complication, macrovascular complication, postprandial triglyceride.