Atherogenic Dyslipidemia and Atherogenic Index of Plasma in Sudanese Adults with Type 2 Diabetes Mellitus: A Case Control Study

Q: What are the key findings of this study?

Atherogenic index of plasma was higher in Sudanese T2DM cases than controls and discriminated T2DM status with an AUC of 0.821.

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Type 2 diabetes mellitus and atherogenic dyslipidemia (n=490). Intervention: Atherogenic index of plasma (AIP) / Type 2 diabetes mellitus vs. Healthy age- and sex-matched controls without diabetes. Primary outcome: Atherogenic index of plasma (AIP) discrimination of T2DM case status vs healthy controls (AUC 0.821, 95% CI 0.784-0.857, p=<0.001).

Q: What does this research mean for the field?

The atherogenic index of plasma is significantly elevated in patients with type 2 diabetes mellitus compared to healthy controls and independently discriminates diabetes status irrespective of glycemic control. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To quantify atherogenic dyslipidemia and evaluate the diagnostic accuracy and independent predictive performance of the atherogenic index of plasma (AIP) in Sudanese adults with type 2 diabetes mellitus compared to healthy controls.

Ahmed A. Siragalnoor; Abdelgadir Elmugadam; Abuagla M. Dafalla; Almoeiz Y Hammad

doi:10.21203/rs.3.rs-11000311/v1

November 12, 2026Open Access

Atherogenic Dyslipidemia and Atherogenic Index of Plasma in Sudanese Adults with Type 2 Diabetes Mellitus: A Case Control Study

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Key result

Higher atherogenic index of plasma discriminates type 2 diabetes with an AUC of ~0.82.

AUC 0.821
95% CI 0.784-0.857
P<0.001
n=490

Why the study?

The atherogenic index of plasma is an inexpensive composite marker of atherogenic lipid risk in patients with type 2 diabetes mellitus, but case-control data quantifying its performance in Sudanese adults with T2DM were lacking.

Does the Atherogenic Index of Plasma (AIP) accurately discriminate Type 2 Diabetes Mellitus status and independently reflect atherogenic lipid burden compared to healthy controls in Sudanese adults?

Key Points

To quantify atherogenic dyslipidemia and evaluate the diagnostic accuracy and independent predictive performance of the atherogenic index of plasma (AIP) in Sudanese adults with type 2 diabetes mellitus compared to healthy controls.
Conducted a case-control study recruiting 245 adults with type 2 diabetes mellitus and 245 age- and sex-matched healthy controls from three teaching hospital outpatient clinics in Al Jazirah State, Sudan.
Measured anthropometric indices, fasting blood glucose, HbA1c, insulin, and fasting lipid profiles after a 10–12-hour fast, calculating AIP as log₁₀(triglycerides/HDL-cholesterol) and estimating insulin resistance via HOMA-IR.
Assessed group differences using the Mann-Whitney U test, evaluated correlations with Spearman's rho, analyzed discriminatory accuracy using ROC curves, and determined independent predictors via binary logistic regression adjusting for age, BMI, and waist–hip ratio.
Adults with diabetes exhibited a significantly higher AIP than healthy controls (median 0.778 vs. 0.497, p < 0.001), alongside significantly higher triglycerides (158 vs. 110 mg/dL, p < 0.001) and lower HDL-C (28 vs. 34 mg/dL, p < 0.001).
AIP discriminated diabetes cases from controls with good accuracy (AUC = 0.821, 95% CI: 0.784–0.857, p < 0.001; optimal cutoff 0.654, sensitivity 75.1%, specificity 73.5%) and independently predicted diabetes status in multivariate regression (Wald = 64.53, p < 0.001; overall accuracy 87.6%).
Among diabetic individuals, AIP correlated significantly with VLDL-C (r = 0.638, p < 0.001) but showed no significant correlation with fasting blood glucose, HbA1c, fasting insulin, or HOMA-IR.

Study Design

Type

Case-Control (n=490)

Multicenter

Yes

Structured PICO

Does the Atherogenic Index of Plasma (AIP) accurately discriminate Type 2 Diabetes Mellitus status and independently reflect atherogenic lipid burden compared to healthy controls in Sudanese adults?

P

Population

490 Sudanese adults (245 with T2DM and 245 age- and sex-matched healthy controls without lipid-lowering therapy, median age 57-60 years, 53.1% female) recruited from three teaching hospitals.

E

Exposure

Atherogenic Index of Plasma (AIP) assessment, calculated as log₁₀(triglycerides/HDL-cholesterol) from a fasting lipid profile after a 10–12-hour overnight fast

C

Comparator

Age- and sex-matched healthy non-diabetic controls (n=245; fasting glucose <100 mg/dL, no known chronic disease, and no lipid-lowering therapy)

O

Outcome

Burden of atherogenic dyslipidemia (AIP levels) and diagnostic/independent predictive performance of AIP for discriminating Type 2 Diabetes Mellitus cases from healthy controlssurrogate

Main Result

Effect estimate: AUC 0.821 (95% CI 0.784-0.857)

Absolute Event Rate: 0.778% vs 0.497%

p-value: p=<0.001

Sudanese adults with T2DM exhibit a substantially higher atherogenic lipid burden than healthy controls, and the Atherogenic Index of Plasma (AIP) serves as an accurate, low-cost, independent marker of this dyslipidemia distinct from glycemic metrics and adiposity.

Limitations

Case-control design precludes causal inference and estimation of true population incidence or relative risk
Recruitment from three centers within a single state in Sudan limits generalizability
Antidiabetic and lipid-lowering medication history was not adjusted for in the multivariable model
Did not include direct clinical cardiovascular endpoints or prospective follow-up
The case-control design precludes causal inference and does not permit estimation of true population incidence or relative risk.
Recruitment from three centers within a single state limits generalizability to other regions of Sudan or other African populations with different dietary and genetic backgrounds.
Data on antidiabetic and lipid-lowering medication history, which could independently influence AIP, were limited to the exclusion criteria applied at enrollment rather than adjusted for in the multivariable model.
The study assessed AIP as a marker of atherogenic risk but did not include direct clinical cardiovascular endpoints.

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Implication

AIP may support dyslipidemia assessment in Sudanese T2DM; hypothesis-generating for diagnostic use pending prospective validation.

Abstract

Background The atherogenic index of plasma (AIP) is an inexpensive composite marker of atherogenic lipid risk that has emerged as a valuable tool in patients with type 2 diabetes mellitus (T2DM), a population which cardiovascular risk is driven substantially by atherogenic dyslipidemia. However case–control data quantifying AIP performance in Sudanese adults with T2DM are lacking. Objective To quantify the burden of atherogenic dyslipidemia and evaluate the diagnostic and independent predictive performance of AIP in Sudanese adults with T2DM relative to healthy controls. Methods In this case control study, 245 adults with T2DM and 245 age- and sex-matched healthy controls were recruited from three teaching hospitals in Al Jazirah State, Sudan. Anthropometric indices and a fasting lipid and glycemic profile were measured, and AIP was calculated as log₁₀(triglycerides/HDL-cholesterol). Group differences were assessed with the Mann-Whitney U and Chi-square tests, associations with Spearman correlation, diagnostic performance with ROC curve analysis, and independent predictors with binary logistic regression adjusting for BMI, waist–hip ratio, and age. Results Cases showed a fully atherogenic lipid profile relative to controls, including significantly higher AIP (median 0.778 vs. 0.497, p < 0.001). Among cases, AIP correlated strongly with VLDL-C (r = 0.638, p < 0.001) but not with FBG, HbA1c, insulin, or HOMA-IR. AIP discriminated cases from controls with good accuracy (AUC = 0.821, 95% CI: 0.784–0.857; optimal cutoff 0.654, sensitivity 75.1%, specificity 73.5%) and remained an independent predictor of T2DM status after adjustment for BMI, waist–hip ratio, and age (Wald = 64.53, p < 0.001; overall model accuracy 87.6%). Conclusion Sudanese adults with T2DM carry a substantially greater atherogenic lipid burden than healthy controls, and AIP is an independent, low-cost marker of this risk that is distinct from glycemic status. AIP may serve as a practical adjunct for cardiovascular risk stratification in resource-limited settings.

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Cite This Study

Siragalnoor et al. (2026) conducted a case-control in Type 2 diabetes mellitus and atherogenic dyslipidemia (n=490). Atherogenic index of plasma (AIP) / Type 2 diabetes mellitus vs. Healthy age- and sex-matched controls without diabetes was evaluated on Atherogenic index of plasma (AIP) discrimination of T2DM case status vs healthy controls (AUC 0.821, 95% CI 0.784-0.857, p=<0.001). Atherogenic index of plasma was higher in Sudanese T2DM cases than controls and discriminated T2DM status with an AUC of 0.821.

synapsesocial.com/papers/6af73ac79badce7b6084da78 https://doi.org/10.21203/rs.3.rs-11000311/v1

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Atherogenic Dyslipidemia and Atherogenic Index of Plasma in Sudanese Adults with Type 2 Diabetes Mellitus: A Case Control Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Atherogenic Dyslipidemia and Atherogenic Index of Plasma in Sudanese Adults with Type 2 Diabetes Mellitus: A Case Control Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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