A Systematic Review on the Impact of Cholesterol Levels on Diabetes Mellitus

Abstract

Diabetes mellitus (DM) is a common metabolic disorder characterized by defects in insulin secretion and action, or both, resulting in chronic hyperglycemia and altered metabolism of carbohydrates, fats, and proteins. In the absence of the major risk factors, diabetes is associated with increased morbidity and mortality from cardiovascular disease. The prevalence of diabetes is 10.1 crores, as per the Indian Council of Medical Research – India Diabetes (ICMR INDIAB) study published in 2023. Serum lipid abnormalities (dyslipidemia) are commonly seen in diabetic populations, irrespective of insulin deficiency or insulin resistance. When insulin activity is very low, it severely inhibits lipoprotein lipase production, which significantly impairs the digestion of triglyceride-rich lipoproteins. As a result, there is an increase in triglyceride-rich lipoproteins and a delay in the clearance of chylomicrons and VLDL. Additionally, insulinopenia leads to a substantial increase in lipolysis in adipose tissue, causing the release of free fatty acids into the bloodstream. This higher supply of fatty acids to the liver improves triglyceride synthesis in the liver, ultimately resulting in increased production and secretion of VLDL. By lowering serum cholesterol with statins, which inhibit 3-hydroxy-3-methylglutaryl-coenzyme A reductase, the rate-limiting enzyme in cholesterol biosynthesis, decreases the risk of CHD.