Comparative Association of Basal and Basal-Prandial Insulin Regimens on Remnant Cholesterol and Lipid Profiles in Patients with Type 2 Diabetes Mellitus

Abstract

Background: The relationship between remnant cholesterol (RC) and insulin therapy is a critical issue in public health. Each insulin regimen used in T2DM patients can have different effects on lipid metabolism. However, clinical evidence comparing the effects of basal insulin and combined basal-prandial insulin on RC levels is limited. Purpose: To investigate and compare the association between basal and basal-prandial insulin regimens on RC and lipid profiles of patients with T2DM using a cross-sectional measurement. Methods: The study involved 118 eligible T2DM patients receiving either basal or combined basal–prandial insulin at Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. Bivariate analysis was performed using the Chi-square test. Multiple logistic regression was used to identify independent factors associated with RC levels. Results: The study reveals that the proportion of patients with normal RC level was significantly greater in the basal-prandial group than in the basal insulin group (49.2% and 30.5%, respectively, p = 0.039). Bivariate analysis showed that the type of insulin regimens was significantly associated with RC (OR 0.454; 95% CI 0.214– 0.965). In multivariate analysis, the association was no longer significant ( p = 0.375), indicating that other factors, such as duration of DM and BMI, contributed to the change in the strength of the association. On the other hand, normal high-density lipoprotein cholesterol (HDL-C) remained an independent protective factor against normal RC (OR, 4.898; 95% CI, 1.484– 16.159; p = 0.009). Conclusion: Compared to basal insulin therapy alone, the combination of basal-prandial insulin regimen was more beneficial in maintaining normal RC levels, although its effects were partially mediated by HDL-C, DM duration, and BMI. Therefore, clinical decisions aimed at improving RC levels in T2DM should consider overall metabolic factors, including HDL-C status, DM duration, and adiposity, rather than on insulin regimen type alone. Keywords: cholesterol, glycosylated hemoglobin, hyperglycemia, insulin regimen, metabolic disorders, type 2 diabetes mellitus

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