Diabetes Mellitus is a global epidemic emerging as a major burden on health care systems. 347 million people worldwide have diabetes. The complications of Diabetes and its impact on quality of life has been extensively studied. The effects of raised blood glucose on other metabolic parameters and pathways are being actively researched upon.

Its precursor Pre-diabetes is closely behind and needs to be extensively evaluated for its associations with other co-morbidities. The global prevalence of prediabetes has been increasing progressively in the past few decades. There is a school of thought that the incidence of pre-diabetes is higher than that of type 2 diabetes mellitus. It has been established that pre-diabetes is a strong risk factor for overt DM and cardiovascular disease. As expected, pre-diabetes also follows a similar pattern with respect to multi-system involvement.

We tend to focus on the impact of high normal sugars in obese individuals, particularly on the fasting lipid profile. Our observations are aimed at deriving a relationship between pre-diabetes sugars and lipid parameters in obese individuals and hence conclude the cumulative effect of these three risk factors in cardiovascular diseases.

This Cross-Sectional study was done over a period of 18 months from 1st 2022 to 31st January 2024 on 150 patients attending Department of General Medicine at KBN Teaching and General Hospital as both outpatients and inpatients. Duration of the study was 18 Months from 1stMarch 2023 to 1stAugust2024. INCLUSION CRITERIA: • Patients in the age group of 18-65. • Patients with a BMI of 25kg/m2 or more. • Patients with a fasting blood glucose between 100 and 125 (both included) and an HbA1C of 5.7 to 6.4. (both included). EXCLUSION CRITERIA: • Patients with- • Diabetes mellitus on insulin or oral hypoglycemics. • Liver diseases with deranged liver function tests. • Chronic kidney disease • Alcohol dependence • Pregnancy and lactating mother Drug therapy on - lipid lowering agents - Oral contraceptive agents - steroids - thiazides - anticoagulants SAMPLE SIZE: 150 Prevalence of hypertension in India was 29.8% 1 Sample size (n) = Z2αPQ/L2 = 140.55 Round figure Sample size n = 150 cases Sampling Procedure: Study subjects will be selected after applying inclusion, exclusion criteria. Information will be collected through prepared proforma from each case by simple random sampling technique. Methods of collection of data After taking ethical approval by the institutional review board for the protocol, record of 150 patients will be randomly selected from the daily record register data, who came to the department in the regular OPD services. STATISTICAL ANALYSIS: Statistical analysis will be analyzed by using IBM SPSS 20.0 version softwarem and the collected data be entered into excel sheet and coded, For qualitative data analysis chi square test is applied For quantitative data analysis t test, ANOVA test and correlation test are applied. Data were expressed in mean ± standard deviation (SD). If P value is <0.05 is considered as significant.

Majority of patients, 43 (28.7%), fell within the age range of 20-30 years. Following closely behind, 37 (24.6%) of patients were in the age group of 41-50 years, while 36 (24.0%) were aged between 51-60 years. Additionally, 27 (18.0%) patients were observed to be in the age range of 31-40 years. The youngest patient was 20 years old, while the oldest was 65 years old. The average age of patients was calculated to be 54.38 years. Notably, there was no statistically significant difference in mean age between genders (P>0.05). Mmale patients were predominant, accounting for 86 (57.3%) of the total patients, while females made up 64 (42.7%) of the patient population. The male to female ratio was calculated to be 1.3:1.

Table No.1: Descriptive statistics of parameters

The mean height of the patients was recorded at 1.60 meters, while the mean weight was 74.65 kg. The average BMI of the patients was calculated to be 28.92 kg/m2. Additionally, the mean total cholesterol level was found to be 188.2 mg/dL, with triglyceride levels averaging at 173.70 mg/dL. The mean High-Density Lipoprotein (HDL) was measured at 39.04 mg/dL, while the Low-Density Lipoprotein (LDL) was 117.02 mg/dL. The mean Very Low-Density Lipoprotein (VLDL) was determined to be 35.56 mg/dL. Furthermore, the mean Fasting Blood Sugar (FBS) level was 112.84 mg/dL, and the mean HbA1C level was 6.04 mmol/mol. Majority of patients, 100 (66.7%), fell into the Obese II BMI category. This was followed by 48 (32.0%) patients who were classified under the Obese III BMI category. Interestingly, no patients were found to be in the Obese I BMI category. The minimum FBS value recorded was 104 mg/dL, while the maximum value reached 125 mg/dL. The average FBS level for male patients was 113.53 mg/dL, and for female patients, it was 111.90 mg/dL. The overall average FBS level for all patients was calculated to be 112.84 mg/dL. Upon analysis, it was determined that there was no statistically significant difference in the mean FBS levels between male and female patients (P>0.05). This suggests that gender does not play a significant role in determining FBS levels among the patients studied.

Table 2: HbA1c wise distribution of patients

NS= not significant, S=significant, HS=highly significant

The range of HbA1c values observed in this study, with the minimum value recorded at 5.6 mmol/mol and the maximum value at 6.5 mmol/mol. The mean HbA1c level for male patients was calculated at 6.03 mmol/mol, while female patients had a slightly higher mean HbA1c level of 6.05 mmol/mol. The overall mean HbA1c level for all patients combined was determined to be 6.04 mmol/mol. Upon statistical analysis, it was found that there was no significant difference in mean HbA1c levels between male and female patients (P>0.05). This suggests that gender does not play a significant role in determining HbA1c levels in this particular patient population. The minimum value recorded was 104 mg/dL, while the maximum value reached 370.0 mg/dL. The mean Total Cholesterol for male patients was calculated at 187.33 mg/dL, whereas female patients had a mean TC of 189.41 mg/dL. The overall mean Total Cholesterol for all patients was 188.22 mg/dL.

It is important to note that there was no statistically significant difference in mean Total Cholesterol levels between male and female patients, as indicated by a P-value greater than 0.05. This suggests that gender does not play a significant role in determining Total Cholesterol levels in this study. The range of LDL values observed in the study, with a minimum of 37 mg/dL and a maximum of 433 mg/dL. The average LDL level for male patients was calculated to be 115.81 mg/dL, while female patients had an average LDL level of 118.66 mg/dL. The overall average LDL level for all patients was found to be 117.02 mg/dL. (p- >0.05).  The minimum TG value recorded was 64 mg/dL, while the maximum value reached 745 mg/dL. The average TG level for male patients was 193.14 mg/dL, and for female patients, it was 147.59 mg/dL. The overall average TG level for all patients was 173.70 mg/dL. (P<0.05).  The minimum value of HDL was 20 mg/dL and the maximum value was 67 mg/dL. The average HDL level in male patients was 37.64 mg/dL, while in female patients it was 40.93 mg/dL. The overall average HDL level for all patients was 39.0 mg/dL. (P<0.05).

The minimum recorded value being 12.8 mg/dL and the maximum value reaching 138.4 mg/dL. The average VLDL level for male patients was calculated to be 38.32 mg/dL, while female patients had an average VLDL level of 31.86 mg/dL. The overall average VLDL level for all patients was determined to be 35.56 mg/dL.  (P>0.05).

Table No.3: Association of BMI with FBS

There was no statistically significant association between fasting blood sugar (FBS),  HbA1c, total cholesterol, LDL, triglyceride levels (TG), HDL levels, VLDL levels  and BMI (P>0.05).

Table 4: Age wise comparison of serum lipid profiles

There was no statistically significant difference in mean height, weight, and BMI between age groups of ≤45 and >45 (P>0.05). Similarly, there was no statistically significant difference in mean TC, LDL, and VLDL between the two age groups (P>0.05). However, there was a statistically significant difference in mean TG, HDL, FBS, and HbA1c levels between the age groups of ≤45 and >45 (P<0.05). Patients in the higher age group exhibited higher TG, FBS, and HbA1c levels, while patients in the lower age group had higher HDL levels.

Table 5: Gender wise comparison of serum lipid profiles

Table 20 presents the results of a study that examined the differences in height, weight, BMI, and various blood markers between males and females. The study found

There was a statistically significant difference in mean height and weight between genders (P>0.05), with males having significantly higher weight and height compared to females. However, there was no statistically significant difference in mean BMI between genders (P<0.05).

Table 6: Correlation of anthropological measurements with serum lipid profiles

There is no statistically significant correlation between height, weight, BMI, and various parameters such as total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), fasting sugar (FBS), and glycated hemoglobin (HbA1c) (P>0.05). These results suggest that height, weight, and BMI may not directly impact the levels of these parameters in the body.

Furthermore, the study also revealed that there is no statistically significant correlation between weight and the aforementioned parameters, as well as between body mass index (BMI) and TC, TG, HDL, LDL, VLDL, FBS, and HbA1c (P>0.05). These findings highlight the need for further research to explore other potential factors that may influence these parameters.

In conclusion, the lack of significant correlations between height, weight, and BMI with TC, TG, HDL, LDL, VLDL, FBS, and HbA1c suggests that additional factors may play a role in determining the levels of these parameters in the body. This underscores the importance of continued research in this area to better understand the complex relationship between anthropometric measurements and metabolic parameters.

Table 7: Assessment of serum lipid profiles with normal and abnormal values

Table 22 presents the findings of a study that examined lipid profiles and blood sugar levels in patients. The study revealed that 49 (32.7%) of patients had abnormal total cholesterol levels, while 56 (37.3%) had abnormal VLDL levels, with statistically significant differences noted (P<0.001).

Furthermore, 84 (56.0%) of patients had abnormal High-Density Lipoprotein (HDL) levels, 88 (58.7%) had abnormal triglyceride (TG) levels, and 85 (56.7%) had abnormal Low-Density Lipoprotein (LDL) levels, all showing statistically significant abnormalities (P<0.05) and (P<0.001).

Additionally, 97 (64.7%) of patients had abnormal Fasting Blood Sugar (FBS) levels, and 136 (90.7%) had abnormal HbA1c levels, both demonstrating statistically significant abnormalities (P<0.001).

These results highlight the prevalence of abnormal lipid profiles and blood sugar levels in the patient population studied, underscoring the importance of monitoring and managing these risk factors for cardiovascular disease and diabetes.

No statistically significant difference in mean age between genders was observed (P>0.05). This age distribution suggests a relatively younger cohort compared to many studies on prediabetes and obesity, which often report a higher prevalence in older populations. For instance, a study by Grundy et al. (2004) reported that dyslipidemia and prediabetes predominantly affect individuals over 40 years, with a peak incidence in the 50-60 age range.2 The lack of gender difference in mean age aligns with findings from Patel et al. (2012), who observed no significant age variation between males and females in prediabetic cohorts.3 Anthropometric Characteristics The mean height of our patients was 1.60 meters, with a mean weight of 74.65 kg, resulting in an average body mass index (BMI) of 28.92 kg/m². Misra et al. (2001) reported that Indian populations exhibit greater visceral fat accumulation at BMIs of 25-30 kg/m² compared to Western counterparts, suggesting a higher metabolic risk at these levels.4 Glycemic Parameters The mean fasting blood sugar (FBS) of 112.84 mg/dL and HbA1c of 6.04 mmol/mol (approximately 6.04%) confirm the prediabetic status of our cohort (FBS 100-125 mg/dL, HbA1c 5.7-6.4%).5 These values align with Indian studies, such as Anjana et al. (2011), who reported a mean FBS of 110-115 mg/dL and HbA1c of 6.0-6.2% in urban prediabetic populations.6 Serum Lipid Profile Our lipid profile revealed a mean total cholesterol (TC) of 188.2 mg/dL, triglycerides (TG) of 173.70 mg/dL, HDL-C of 39.04 mg/dL, LDL-C of 117.02 mg/dL, and VLDL of 35.56 mg/dL. This pattern reflects atherogenic dyslipidemia, characterized by elevated TG, reduced HDL-C, and borderline LDL-C, a common finding in obese prediabetics.7 The HDL-C of 39.04 mg/dL, below optimal levels (>40 mg/dL for men, >50 mg/dL for women), aligns with Misra et al. (2009), who noted mean HDL-C values of 38-40 mg/dL in urban Indian adults with metabolic syndrome.8 The TC of 188.2 mg/dL, below the high-risk threshold (<200 mg/dL), is similar to Anjana et al. (2011), who reported a mean TC of 185-190 mg/dL in prediabetic Indians.7 HbA1c Levels and Glycemic Control Our study recorded HbA1c levels ranging from a minimum of 5.6 mmol/mol to a maximum of 6.5 mmol/mol, corresponding to approximately 5.6% to 6.5% in conventional units. This range falls within the diagnostic criteria for prediabetes (5.7-6.4%) as per the American Diabetes Association9, confirming the prediabetic status of our study. Total Cholesterol Levels The overall mean TC of 188.22 mg/dL in our study falls below the high-risk threshold of 200 mg/dL, suggesting a moderate lipid abnormality in our obese prediabetic cohort. The gender-specific means—187.33 mg/dL in males and 189.41 mg/dL in females—indicate a slight elevation in females, though the difference (2.08 mg/dL) appears minimal and likely not statistically significant without further analysis. This TC level reflects the early dyslipidemic changes typical in prediabetes, where insulin resistance begins to alter lipid metabolism.10 Glycemic Parameters The mean fasting blood sugar (FBS) of 112.84 mg/dL and HbA1c of 6.04 mmol/mol (approximately 6.04% in conventional units) align with the diagnostic criteria for prediabetes (FBS 100-125 mg/dL, HbA1c 5.7-6.4%).11 Serum Lipid Profile Our study found a mean total cholesterol (TC) of 188.2 mg/dL, triglycerides (TG) of 173.70 mg/dL, HDL-C of 39.04 mg/dL, LDL-C of 117.02 mg/dL, and VLDL of 35.56 mg/dL. This profile reflects a pattern of atherogenic dyslipidemia, characterized by elevated TG, reduced HDL-C, and moderately elevated LDL-C, which is a hallmark of obese prediabetes.12 The mean HDL-C of 39.04 mg/dL is below the recommended levels (>40 mg/dL for men, >50 mg/dL for women), consistent with the reduced HDL-C observed in metabolic syndrome by Grundy et al. (2004).13 Our lipid profile aligns with the atherogenic dyslipidemia pattern widely documented in obese prediabetics. The elevated TG and reduced HDL-C are consistent with findings from Reaven (2005) and Bays et al. (2008), reflecting the metabolic consequences of insulin resistance.7 Glycemic Parameters- Fasting Blood Sugar (FBS) The mean fasting blood sugar (FBS) of 112.84 mg/dL and HbA1c of 6.04 mmol/mol (approximately 6.04%) confirm the prediabetic status of our study (FBS 100-125 mg/dL, HbA1c 5.7-6.4%).43 These values align with Indian studies, such as Anjana et al. (2011), who reported a mean FBS of 110-115 mg/dL and HbA1c of 6.0-6.2% in urban prediabetic populations.14 Gender Differences Our finding of a slightly higher TC in females (189.41 mg/dL) than males (187.33 mg/dL) mirrors some Indian literature. Misra et al. (2009) noted a trend of higher TC in females (190-200 mg/dL) compared to males (185-195 mg/dL) in obese Indian adults, potentially due to postmenopausal hormonal changes affecting lipid metabolism4. Overall, our study findings are consistent with existing literature, particularly studies from India and South India, reinforcing the observation that triglyceride levels vary based on gender, region, and lifestyle factors. The discrepancies observed in certain studies highlight the influence of genetic, dietary, and environmental factors on lipid metabolism in prediabetic individuals. Further large-scale studies are needed to establish population-specific lipid profile reference ranges and to explore targeted interventions for dyslipidemia in obese prediabetics. Overall, our study findings are consistent with existing literature, particularly studies from India and South India, reinforcing the observation that HDL levels vary based on gender, region, and lifestyle factors. The discrepancies observed in certain studies highlight the influence of genetic, dietary, and environmental factors on lipid metabolism in prediabetic individuals. Further large-scale studies are needed to establish population-specific lipid profile reference ranges and to explore targeted interventions for maintaining optimal HDL levels in obese prediabetics.

The study demonstrates a high prevalence of abnormal lipid profiles and elevated blood sugar levels among obese prediabetic patients, with significant implications for cardiovascular and diabetes risk.

Gender differences were notable in triglyceride (TG) and high-density lipoprotein (HDL) levels, with males exhibiting higher TG and females showing higher HDL levels, though no significant gender differences were observed in total cholesterol (TC), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), fasting blood sugar (FBS), or HbA1c.

Age influenced TG, HDL, FBS, and HbA1c levels, with older patients (>45 years) showing higher TG, FBS, and HbA1c, and younger patients (≤45 years) exhibiting higher HDL levels. The majority of patients were classified as Obese II or III, with no representation in the Obese I category, indicating severe obesity in this prediabetic population. Statistically significant abnormalities in lipid profiles (TC, TG, HDL, LDL, VLDL) and glycemic markers (FBS, HbA1c) underscore the need for targeted interventions in this high-risk group.

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