Relationship Between HbA1c Levels and Atherogenic Index of Plasma in Diabetic Nephropathy Patients
DOI:
https://doi.org/10.37287/ijghr.v8i1.577Keywords:
ACR, AIP, CVD, HbA1cAbstract
Diabetic nephropathy is the leading cause of kidney failure worldwide. Its incidence is comparable to that of cardiovascular disease (CVD), with macrovascular complications remaining the main cause of death among diabetic patients. The Atherogenic Index of Plasma (AIP) is an independent marker and predictor of CVD. AIP indicates risk even when other atherogenic risk factors are normal, categorized as low risk (AIP < 0.11), intermediate risk (AIP 0.11–0.21), and high risk (AIP > 0.21). This study aims to explore the relationship between Glycated Hemoglobin (HbA1c) levels and AIP in patients with diabetic nephropathy to identify the risk of CVD complications. It used a prospective analytical design with a cross-sectional approach, conducted at Adam Malik Hospital, Medan, from February to May 2025. Forty-three outpatients with diabetic nephropathy who met the inclusion criteria were selected using a consecutive sampling technique. Patients were assessed for HbA1c, triglycerides, HDL, and urinary albumin-to-creatinine ratios. AIP was calculated by taking the logarithm of (triglycerides/HDL). Data analysis involved Pearson and Spearman correlation tests. A significant positive correlation was found between HbA1c and AIP (r = 0.670, p = 0.000), as well as between HbA1c and triglycerides (r = 0.398, p = 0.008). A significant negative correlation was observed between HbA1c and HDL (r = -0.648, p = 0.000). However, there was no significant correlation between HbA1c and ACR, nor between ACR and AIP (p > 0.05). In conclusion, higher HbA1c levels are associated with increased AIP levels, which elevate the risk of CVD, characterized by rising triglycerides and decreasing HDL.
References
Abdissa, D., & Hirpa, D. (2022). Dyslipidemia and its associated factors among adult diabetes outpatients in West Shewa zone public hospitals, Ethiopia. BMC Cardiovascular Disorders, 22(1), 39. https://doi.org/10.1186/s12872-022-02489-w
Abera, R. G., Demesse, E. S., & Boko, W. D. (2022). Evaluation of glycemic control and related factors among outpatients with type 2 diabetes at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study. BMC Endocrine Disorders, 22(1), 54. https://doi.org/10.1186/s12902-022-00974-z
Alam, M. F., Ahmed, J. U., Jahan, I., & Roy, S. C. (2021). The Usefulness of Glycated Hemoglobin (HbA1c) in the Detection of Diabetes Mellitus. Asian Journal of Medicine and Health, 1–5. https://doi.org/10.9734/ajmah/2021/v19i1230409
Anjankar, A. P., Kale, A. b, & Sharma, P. L. (2018). CORRELATION BETWEEN HBA1C AND ATHEROGENIC INDEX IN TYPE 2 DIABETIC PATIENTS. International Journal of Current Advanced Research, 7(8), 14789–14793. https://doi.org/http://dx.doi.org/10.24327/ijcar.2018.14793.2695
Aydın, B., Özçelik, S., Kilit, T. P., Eraslan, S., Çelik, M., & Onbaşı, K. (2022). Relationship between glycosylated hemoglobin and iron deficiency anemia: A common but overlooked problem. Primary Care Diabetes, 16(2), 312–317. https://doi.org/10.1016/j.pcd.2022.01.002
Badan Kebijakan Pembangunan Kesehatan. (2024, November). Survei Kesehatan Indonesia (SKI). KEMENKES.
Butt, B., Ghulam, B., Bashir, Z., Abbasi, S. R., Hussain, S., Jadoon, S. K., Akbar, A., & Khan, M. A. (2024). Enhanced Creatinine Level in Diabetic Patients Maximizing the Possibilities of Nephropathy and Its Association With Blood Urea Nitrogen and Glomerular Filtration Rate. Cureus. https://doi.org/10.7759/cureus.70482
Campbell, L., Pepper, T., & Shipman, K. (2019). HbA1c: A review of non-glycaemic variables. In Journal of Clinical Pathology (Vol. 72, Issue 1, pp. 12–19). BMJ Publishing Group. https://doi.org/10.1136/jclinpath-2017-204755
Cao, H., Song, L., Wang, X., & Guan, H. (2025). Non-linear relationship between urinary creatinine and diabetic kidney disease: implications for clinical practice. BMC Nephrology, 26(1), 40. https://doi.org/10.1186/s12882-025-03971-1
Chen, S., & Tseng, C.-H. (2019). Dyslipidemia, Kidney Disease, and Cardiovascular Disease in Diabetic Patients. The Review of Diabetic Studies, 10(2–3), 88–100. https://doi.org/10.1900/RDS.2013.10.88
CS, L., & TC, A. (2020). HbA1c in the diagnosis and management of diabetes mellitus: an update. Diabetes Updates, 6(1). https://doi.org/10.15761/du.1000137
DEEPESH MAKHIJANI, GAJENDRA MAHISHALE, & BILAL BIN ABDULLAH. (2024). A prospective study of correlation between microalbuminuria and atherogenic index in evaluating coronary vascular risk in newly diagnosed type 2 diabetes mellitus patients. International Journal of Science and Research Archive, 13(2), 1080–1087. https://doi.org/10.30574/ijsra.2024.13.2.2241
Esfandiari, F., Fitriani, D., Nur, M., & Fitri, D. S. (2023). HUBUNGAN HbA1c DENGAN KADAR HDL PADA PENDERITA DIABETES MELLITUS TIPE 2 DI PUSKESMAS SIMPUR BANDAR LAMPUNG. Jurnal Ilmu Kedokteran Dan Kesehatan, 10(8), 2508–2515. https://doi.org/10.33024/jikk.v10i8.9661
Fawwad, A., Mahmood, Y., Askari, S., Butt, A., Basit, A., Rehman Abro, M. U., Ahmed, K. I., Ahmed, K., Ali, S. S., Bilal, A., Butt, A., Devrajani, B. R., Hayder, I., Humayun, Y., Irshad, R., Khan, R. A., Khan, A., Khowaja, A. A., Khowaja, R., … Zafar, J. (2023). NDSP 12: Atherogenic index of plasma as a useful marker of cardiovascular disease risk among Pakistani individuals; a study from the second National Diabetes Survey of Pakistan (NDSP) 2016–2017. Clinical Epidemiology and Global Health, 19, 101202. https://doi.org/10.1016/j.cegh.2022.101202
Giandalia, A., Giuffrida, A. E., Gembillo, G., Cucinotta, D., Squadrito, G., Santoro, D., & Russo, G. T. (2021). Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors. International Journal of Molecular Sciences, 22(11). https://doi.org/10.3390/ijms22115808
Jialal, I., & Singh, G. (2019). Management of diabetic dyslipidemia: An update. World Journal of Diabetes, 10(5), 280–290. https://doi.org/10.4239/wjd.v10.i5.280
Jung, C.-Y., & Yoo, T.-H. (2022). Pathophysiologic Mechanisms and Potential Biomarkers in Diabetic Kidney Disease. Diabetes & Metabolism Journal, 46(2), 181–197. https://doi.org/10.4093/dmj.2021.0329
Kim, S. H., Cho, Y. K., Kim, Y.-J., Jung, C. H., Lee, W. J., Park, J.-Y., Huh, J. H., Kang, J. G., Lee, S. J., & Ihm, S.-H. (2022). Association of the atherogenic index of plasma with cardiovascular risk beyond the traditional risk factors: a nationwide population-based cohort study. Cardiovascular Diabetology, 21(1), 81. https://doi.org/10.1186/s12933-022-01522-8
Lee, Y., Han, K., Kim, B., Choi, M. S., Park, J., Kim, M., Jin, S., Hur, K. Y., Kim, G., & Kim, J. H. (2021). Risk of early mortality and cardiovascular disease according to the presence of recently diagnosed diabetes and requirement for insulin treatment: A nationwide study. Journal of Diabetes Investigation, 12(10), 1855–1863. https://doi.org/10.1111/jdi.13539
Lian, H., Wu, H., Ning, J., Lin, D., Huang, C., Li, F., Liang, Y., Qi, Y., Ren, M., Yan, L., You, L., & Xu, M. (2021). The Risk Threshold for Hemoglobin A1c Associated With Albuminuria: A Population-Based Study in China. Frontiers in Endocrinology, 12. https://doi.org/10.3389/fendo.2021.673976
Liu, L., Xia, R., Song, X., Zhang, B., He, W., Zhou, X., Li, S., & Yuan, G. (2021). Association between the triglyceride-glucose index and diabetic nephropathy in patients with type 2 diabetes: A cross-sectional study. Journal of Diabetes Investigation, 12(4), 557–565. https://doi.org/10.1111/jdi.13371
Ma, C.-X., Ma, X.-N., Guan, C.-H., Li, Y.-D., Mauricio, D., & Fu, S.-B. (2022). Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management. Cardiovascular Diabetology, 21(1), 74. https://doi.org/10.1186/s12933-022-01516-6
Nosrati, M., Safari, M., Alizadeh, A., Ahmadi, M., & Mahrooz, A. (2021). The Atherogenic Index Log (Triglyceride/HDL-Cholesterol) as a Biomarker to Identify Type 2 Diabetes Patients with Poor Glycemic Control. International Journal of Preventive Medicine, 12, 160. https://doi.org/10.4103/ijpvm.IJPVM_357_20
Parcero-Valdés, J. J. (2021). Dislipidemia diabética. Cardiovascular and Metabolic Science, 32(S3), 168–172. https://doi.org/10.35366/100791
PB. PERKENI. (2021, July). Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa di Indonesia.
Prabandari, N. P. S. S., Wirawati, I. A. P., & Mahartini, N. N. (2021). Relationship between Atherogenic Index of Plasma with HbA1c Levels in Type 2 Diabetes Mellitus Patients. Indonesian Journal of Clinical Pathology and Medical Laboratory, 28(1), 71–74.
Putri, M. G., Heri, K., Hs, N., Adi, M. S., Suhartono, S., & Widjanarko, B. (2020). Faktor Risiko Durasi Diabetes Melitus Tipe 2 dan Ketidakpatuhan Minum Obat terhadap Status Glikemik Buruk. Jurnal Berkala Epidemiologi, 8, 256–264. https://doi.org/10.20473/jbe.v8i32020
Ragab, U., Selim, F., Agroody, A., Mourad, M., & Sakr, M. (2020). Role of the atherogenic index of plasma in the prediction of the urinary albumin excretion and macrovascular complications in patients with type 2 diabetes. Family Medicine & Primary Care Review, 22(4), 312–318. https://doi.org/10.5114/fmpcr.2020.100437
Šebeková, K., Gurecká, R., Csongová, M., Koborová, I., & Celec, P. (2023). Association of Atherogenic Index of Plasma with Cardiometabolic Risk Factors and Markers in Lean 14-to-20-Year-Old Individuals: A Cross-Sectional Study. Children (Basel, Switzerland), 10(7). https://doi.org/10.3390/children10071144
Sharma, A., Mittal, S., Aggarwal, R., & Chauhan, M. K. (2020). Diabetes and cardiovascular disease: inter-relation of risk factors and treatment. Future Journal of Pharmaceutical Sciences, 6(1), 130. https://doi.org/10.1186/s43094-020-00151-w
Sindi, F., Aumas Pabuti, & Eka Agustia Rini. (2023). The Relationship between Metabolic Control Status and Microalbuminuria in Pediatric Diabetes Mellitus Patients at Dr. M. Djamil General Hospital, Padang, Indonesia. Bioscientia Medicina : Journal of Biomedicine and Translational Research, 7(1), 3038–3042. https://doi.org/10.37275/bsm.v7i1.757
Soeatmadji, D. W., Rosandi, R., Saraswati, M. R., Sibarani, R. P., & Tarigan, W. O. (2023). Clinicodemographic Profile and Outcomes of Type 2 Diabetes Mellitus in the Indonesian Cohort of DISCOVER: A 3-Year Prospective Cohort Study. Journal of the ASEAN Federation of Endocrine Societies, 38(1), 68–74. https://doi.org/10.15605/jafes.038.01.10
Swamy, S., Noor, S. M., & Mathew, R. O. (2023). Cardiovascular Disease in Diabetes and Chronic Kidney Disease. Journal of Clinical Medicine, 12(22), 6984. https://doi.org/10.3390/jcm12226984
Tang, X., Yan, X., Zhou, H., Huang, G., Niu, X., Jiang, H., Su, H., Yang, X., Li, X., & Zhou, Z. (2022). Associations of insulin resistance and beta-cell function with abnormal lipid profile in newly diagnosed diabetes. Chinese Medical Journal, 135(21), 2554–2562. https://doi.org/10.1097/CM9.0000000000002075
Thomas, M. C., Brownlee, M., Susztak, K., Sharma, K., Jandeleit-Dahm, K. A. M., Zoungas, S., Rossing, P., Groop, P.-H., & Cooper, M. E. (2015). Diabetic kidney disease. Nature Reviews Disease Primers, 1(1), 15018. https://doi.org/10.1038/nrdp.2015.18
Vujicic, B., Turk, T., Crncevic-Orlic, Z., orevic, G., & Racki, S. (2012). Diabetic Nephropathy. In Pathophysiology and Complications of Diabetes Mellitus (pp. 71–96). InTech. https://doi.org/10.5772/50115
World Health Organization. (2019). CLASSIFICATION OF DIABETES MELLITUS 2019. http://apps.who.int/bookorders.
World Health Organization. (2020). Diagnosis and Management of Type 2 Diabetes.
World Health Organization. (2021). Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus.
Yuvaraj, J., Isa, M., Che, Z. C., Lim, E., Nerlekar, N., Nicholls, S. J., Seneviratne, S., Lin, A., Dey, D., & Wong, D. T. L. (2022). Atherogenic index of plasma is associated with epicardial adipose tissue volume assessed on coronary computed tomography angiography. Scientific Reports, 12(1), 9626. https://doi.org/10.1038/s41598-022-13479-5
Zhu, L., Lv, T., Song, S., Tan, Y., She, Y., Zhou, X., Yu, J., & Yan, Q. (2025). Association of atherogenic index of plasma with kidney dysfunction in diabetic individuals: findings from two national population-based studies. BMC Endocrine Disorders, 25(1), 105. https://doi.org/10.1186/s12902-025-01925-0
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Indonesian Journal of Global Health Research

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.







