Paradoxical Hepatic-lipid Associations in Libyan Type 2 Diabetes: A Case-control Study

Abstract

Prevalence of type 2 diabetes mellitus (T2DM) in Libya is high and often accompanied by the presence of metabolic dysfunction-associated steatotic liver disease (MASLD) and atherogenic dyslipidemia. This case-control study explored associations of liver biomarkers with lipid profile parameters in Libyan adults with T2DM versus non-diabetic controls. The study included 176 individuals (89 patients with T2DM and 87 age- and sex-matched controls). Levels of biochemical parameters, including ALP, ALT, AST, TB, DB, TP, Alb, TG, TC, HDL-C, and LDL-C, were measured using automated assays. Statistical methods used in this study include the Mann-Whitney U test, Spearman's correlation, MANOVA, and linear regression. The T2DM group demonstrated statistically significant decreases in ALP (p=0.030), TB (p=0.010), and DB (p=0.001) levels compared to the control group. No statistically significant difference was found for ALT, AST, TP, albumin, TG, TC, HDL C and LDL C levels. Inverse correlation was found between the following parameters: ALT with HDL C (r=−0.187, p=0.013); TB with HDL C (r=−0.153, p=0.043) and LDL C (r=−0.217, p=0.004); DB with TC (r=−0.215, p=0.004) and LDL C (r=−0.279, p<0.001); TP with HDL C (r=−0.226, p=0.003). FBS was found to be an independent predictor of ALP (B=−0.262, p=0.010), AST (B=−0.038, p=0.047) and TG (B=0.774, p=0.002). Gender had a significant impact on several parameters: males had higher ALT (p=0.032), TB (p=0.032), DB (p=0.002), and TG (p=0.015), whereas females had higher TC (p=0.039), HDL C (p=0.001) and LDL C (p=0.008). Neither age nor BMI category had a significant effect on any studied parameter (all p>0.05). Decreased levels of ALP and bilirubin in Libyan patients with T2DM and inverse correlation between liver biomarkers (ALT, bilirubin fractions, TP) and lipid parameters (HDL C, LDL C, TC) demonstrate an association of hepatic function with lipid metabolism independent of elevation of traditional liver biomarkers. Gender-specific changes underline the necessity of developing a sex-tailored monitoring strategy. Regular measurement of ALP, bilirubin, and FBS along with lipid profiles can help detect early stages of metabolic impairment in this population.