Diagnostic Accuracy and Cut-off Values of Atherogenic Lipid Indices for Identifying Elevated HbA1c in Adults

Q: What are the key findings of this study?

Atherogenic index of plasma demonstrated the highest diagnostic accuracy for identifying HbA1c >6.5% (AUC 0.825, 95% CI 0.765-0.883; p 0.145 (78.0% sensitivity, 74.7% specificity).

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Type 2 Diabetes Mellitus (n=200). Intervention: Atherogenic index of plasma (AIP) vs. Individual lipid parameters (TG, TC, LDL-C, HDL-C, VLDL-C). Primary outcome: Discrimination of elevated HbA1c (>6.5% vs ≤6.5%) by ROC curve analysis (AUC 0.825, 95% CI 0.765-0.883, p=<0.001).

Q: What does this research mean for the field?

The atherogenic index of plasma discriminates elevated HbA1c (>6.5%) with higher diagnostic accuracy than conventional individual lipid parameters, achieving an AUC of 0.825 at a cut-off greater than 0.145. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ahmed Nouri Alsharksi; Siraj Hamad; Abdalla Ali

doi:10.54361/ajmas.261040

October 26, 2026AlQalam Journal of Medical and Applied SciencesOpen Access

Diagnostic Accuracy and Cut-off Values of Atherogenic Lipid Indices for Identifying Elevated HbA1c in Adults

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Key result

Atherogenic index of plasma best identifies elevated HbA1c with an AUC of ~0.83.

AUC 0.825
95% CI 0.765-0.883
P<0.001
n=200

Why the study?

Atherogenic dyslipidemia is closely associated with insulin resistance, motivating an evaluation of the discriminatory performance of the atherogenic index of plasma (AIP) and other lipid parameters in distinguishing adults with HbA1c >6.5% from those with HbA1c <=6.5%.

Does the atherogenic index of plasma (AIP) improve the discrimination of elevated HbA1c (>6.5%) compared to individual lipid measurements in adults with Type 2 Diabetes Mellitus?

Key Points

To evaluate the discriminatory performance and determine cut-off values of the atherogenic index of plasma (AIP) and individual lipid parameters in distinguishing adults with elevated HbA1c (>6.5%) from those with HbA1c ≤6.5%.
Included 200 adults (mean age 45.26 ± 10.71 years; 59% female) categorized into two equal groups: 100 with HbA1c ≤6.5% and 100 with HbA1c >6.5%.
Measured lipid parameters following a 12-hour fast and calculated AIP as the logarithm of the triglyceride-to-HDL-C ratio.
Assessed discriminatory performance and optimal diagnostic cut-offs using receiver operating characteristic (ROC) curve analysis and the Youden index.
AIP showed the highest discriminatory accuracy for elevated HbA1c (AUC = 0.825, 95% CI: 0.765–0.883; p < 0.001), with an optimal cut-off of >0.145 yielding 78.0% sensitivity and 74.7% specificity.
Triglycerides demonstrated good discrimination (AUC = 0.791, 95% CI: 0.728–0.854; p < 0.001; cut-off >135.5 mg/dL), whereas total cholesterol (AUC = 0.682, 95% CI: 0.607–0.757; p < 0.001) and LDL-C (AUC = 0.645, 95% CI: 0.567–0.723; p = 0.001) demonstrated weaker discrimination.
HDL-C exhibited an inverse discriminatory relationship with elevated HbA1c (AUC = 0.312, 95% CI: 0.237–0.387; p < 0.001; cut-off <42.5 mg/dL).

Study Design

Type

Case-Control (n=200)

Multicenter

No

Structured PICO

Does the atherogenic index of plasma (AIP) improve the discrimination of elevated HbA1c (>6.5%) compared to individual lipid measurements in adults with Type 2 Diabetes Mellitus?

P

Population

200 adults aged 25-60 years (mean age 45.26 years, 59% female) with confirmed Type 2 Diabetes Mellitus not receiving lipid-lowering therapy, divided into 100 cases with poor glycemic control (HbA1c >6.5%) and 100 controls with well-controlled glycemic status (HbA1c ≤6.5%).

E

Exposure

Atherogenic Index of Plasma (AIP), calculated as log10(TG / HDL-C) using concentrations in mg/dL obtained after a 12-hour overnight fast

C

Comparator

Conventional individual lipid measurements: triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and very-low-density lipoprotein cholesterol (VLDL-C)

O

Outcome

Discriminatory performance (area under the ROC curve [AUC], optimal cut-off values via Youden Index, sensitivity, and specificity) for distinguishing individuals with elevated HbA1c (>6.5%) from those with controlled HbA1c (<=6.5%)surrogate

Main Result

Effect estimate: AUC 0.825 (95% CI 0.765-0.883)

p-value: p=<0.001

The atherogenic index of plasma (AIP) demonstrates good discriminatory accuracy (AUC 0.825) for identifying poor glycemic control (HbA1c >6.5%) in adults with type 2 diabetes, serving as a useful adjunctive cardiometabolic marker.

Limitations

AIP was calculated using TG and HDL-C concentrations in mg/dL rather than conventional molar concentrations (mmol/L)
Lack of formal statistical comparison between correlated ROC curves to establish superiority of AIP over triglycerides
Unadjusted analysis without accounting for potential confounders such as age, sex, adiposity, glucose-lowering medication use, and diabetes duration
Single-sample hospital-based design limits generalizability of the proposed cut-off value and prevents causal or prospective inference
Findings represent discriminatory performance within the studied population rather than proof of causality or prospective predictive ability
No formal statistical comparison of the correlated ROC curves between AIP and TG was performed
Calculated AIP using mg/dL directly without conversion to molar concentrations (mmol/L), affecting direct comparison with other studies
Lack of multivariable adjustment for potential confounding factors such as age, sex, adiposity, medication use, and diabetes duration
Cut-off threshold is a study-specific estimate and not necessarily generalizable to other populations

Implication

May complement lipid assessment for HbA1c screening; leaves open incremental value over standard parameters in prospective cohorts.

Abstract

Atherogenic dyslipidemia, characterized by elevated triglyceride (TG) levels and reduced high-density lipoprotein cholesterol (HDL-C), is closely associated with insulin resistance and an unfavorable cardiometabolic profile. The atherogenic index of plasma (AIP), calculated as the logarithm of the TG-to-HDL-C ratio, integrates these lipid parameters into a single indicator of atherogenic risk. This study aimed to evaluate the discriminatory performance of AIP and other lipid parameters in distinguishing individuals with HbA1c >6.5% from those with HbA1c ≤6.5%. The supplied study results included 200 adults divided into two equal groups according to HbA1c: 100 participants with HbA1c ≤6.5% and 100 with HbA1c >6.5%. Lipid measurements were obtained after a 12-hour fast. Receiver operating characteristic (ROC) analysis and the Youden index were used to assess discrimination and identify cut-off values. Mean age was 45.26 ± 10.71 years; 59% were female. AIP had the highest reported area under the ROC curve (AUC = 0.825, 95% CI: 0.765–0.883; p < 0.001). The reported optimal AIP cut-off was >0.145, with 78.0% sensitivity and 74.7% specificity. TG also showed good discrimination (AUC = 0.791, 95% CI: 0.728–0.854; p < 0.001), whereas total cholesterol (AUC = 0.682), LDL-C (AUC = 0.645), and HDL-C (AUC = 0.312) showed weaker or directionally inverse discrimination. Conclusion: This study highlights the potential value of AIP as an adjunctive marker for identifying an atherogenic lipid profile associated with elevated HbA1c. AIP should be interpreted as a complementary cardiometabolic indicator rather than a replacement for established glycemic assessment methods.

Discussion

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Cite This Study

Alsharksi et al. (2026) conducted a case-control in Type 2 Diabetes Mellitus (n=200). Atherogenic index of plasma (AIP) vs. Individual lipid parameters (TG, TC, LDL-C, HDL-C, VLDL-C) was evaluated on Discrimination of elevated HbA1c (>6.5% vs ≤6.5%) by ROC curve analysis (AUC 0.825, 95% CI 0.765-0.883, p=<0.001). Atherogenic index of plasma demonstrated the highest diagnostic accuracy for identifying HbA1c >6.5% (AUC 0.825, 95% CI 0.765-0.883; p<0.001) at a cut-off >0.145 (78.0% sensitivity, 74.7% specificity).

synapsesocial.com/papers/6ae13d0f043bfbd63533285d https://doi.org/10.54361/ajmas.261040

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Diagnostic Accuracy and Cut-off Values of Atherogenic Lipid Indices for Identifying Elevated HbA1c in Adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Diagnostic Accuracy and Cut-off Values of Atherogenic Lipid Indices for Identifying Elevated HbA1c in Adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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