ASSESSMENT OF TRIGLYCERIDES TO HIGH DENSITY

LIPOPROTEIN CHOLESTEROL RATIO AND C-REACTIVE

PROTEIN AMONG TYPE 2 DIABETIC PATIENTS AT SOMALI
SUDANESE HOSPITAL IN MOGADISHO SOMALIA

BY

MAHAD ABDI MOHAMED 128928

YASIIN ARTAN BARE 130942
FARTUN ABDI OSMAN 129317
NASTEXO HASSAN MOHAMUD 129280

A THESIS
PRESENTED TO THE FACULTY OF HEALTH SCIENCE
SOMALI INTERNATIONAL UNIVERSITY, MOGADISHU –
SOMALIA.

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR

THE BACHELORS DEGREE BACHELOR OF MEDICAL
LABORATORY SCIENCE

June 2023

i
 DECLARATION A

We are hereby declared that the thesis is from our own work and effort and that it was not been
submitted anywhere for any award. All other sources of information used have been
acknowledged

Researcher’s Names

1. Mahad Abdi Mohamed

Signature: Date / /

2. Yasiin Cartan Barre

Signature: Date / /

3. Fartuun Abdi Osman

Signature: Date / /

4. Nastexo Hassan Mohamud

Signature: Date / /

i
 DECLARATION B

I confirm that the work in this thesis report was done by the candidate under my direct Supervision

Supervisor name:

Dr.: Mohamed mahamuud abdulle

Signature Date /_ /

ii
 DEDICATION

We dedicate this Thesis to our beloved fathers who taught us that the best kind of knowledge to
have been that which is learned for own sake, and mothers who taught us that even the largest
task can be accomplished if it’s done one step at a time. All members of our family have been
extremely supportive in terms of financial, spiritual and moral edifications throughout the time
we are busy writing this proposal.

ii
 ACKNOWLEDGMENT

First, we thank Almighty Allah for giving us the lives and strength to study and allowed to us to
make this research proposal. And Praise is to Allah, and blessings and peace is upon to our
Prophet Mohamed and upon all his Family and Companions Secondly, we would like to give
countless thanks to our honorable dean of the faculty of health Mr. Mohamed Mohamud Abdulle
and all our lectures we can’t list all the names here, but you are always on our minds. And also,
he is our supervisor who was great activist and contributor with his enthusiasm, his inspiration,
and his great efforts to explain things clearly and simply. Throughout our proposal writing
period, he provided encouragement, sound advice, good teaching, good company, and lots of
good ideas. We would have been lost without him. We are very grateful to Somali International
University (SIU) for its academic and mentorship support during our entire Bachelor study
period. It is a pleasure to thank the many people who made this proposal possible.

Lastly, and most importantly, we thank our parents for their support and encouragement during
our entire study time.

i
 ABBREVIATIONS

D.M: diabetic mellitus

TG: triglycerides

HDL: high density lipoprotein

LDL: low density lipoprotein

CVD: cardiovascular disease

T2DM: type 2 diabetic mellitus

CHD: Coronary heart disease

FPG: Fasting plasma glucose

IDF: international diabetic federation

IR: Insulin Resistence

CRP: C-Reactive protein

v
 Table of Contents

DECLARATION A........................................................................................................................................i
DECLARATIOB..........................................................................................................................................ii.
DEDICATION...........................................................................................................................................iii
ACKNOWLEDGMENT..................................................................................................................................iv
ABBREVIATIONS........................................................................................................................................v
LIST OF TABLES..........................................................................................................................................viii
ABSTRACT....................................................................................................................................................ix
CHAPTER ONE......................................................................................................................................1
1.0 Background............................................................................................................................................1

1.1 Problem statement................................................................................................................................2

1.2 Objective of this study..........................................................................................................................3

1.2.1 General of objective...........................................................................................................................3

1.2.2 Specific of objective............................................................................................................................3
1.3 Research question.................................................................................................................................3

1.4 Scope of the study.................................................................................................................................3

1.4.1 Time of scope.....................................................................................................................................3

1.4.2 Geographical scope............................................................................................................................3
1.5 Significance of the study.......................................................................................................................4

1.6 Operational key terms...........................................................................................................................4

chapter Two.........................................................................................................................................5
2.0 Introduction..........................................................................................................................................5
2.1 Ratio between triglyceride and high-density Lipoprotein (HDL)................................................6
2.2 the relationship between triglyceride, HDL and CRP with duration type two diabetic
patients........................................................................................................................7
2.3 Related studies....................................................................................................................................10
CHAPTER THREE.................................................................................................................................11
3.0 Overview.............................................................................................................................................11
3.1 Study design....................................................................................................................................11
3.2 Study Area........................................................................................................................................11
3.3 Target population................................................................................................................................11

v
3.4 Sample size...........................................................................................................................................11
3.5 Sampling technique..........................................................................................................................12
3.6 Research instrument..........................................................................................................................12
3.7 laboratory procedure..........................................................................................................................12
3.8 Validity and reliability of the instrument.........................................................................................12
3.9 Data gathering procedure....................................................................................................................12
3.10Dataanalysis.......................................................................................................................................13
3.11 Ethical considerations........................................................................................................................13
3.12 Limitations of the study.....................................................................................................................14

CHAPTER FOUR...........................................................................................................................................15
DATA ANALYSIS AND INTERPERETATION...................................................................................................15
CHAPTER FIVE.............................................................................................................................................16
5.1 FINDINGS...............................................................................................................................................16
5.2 DISCUSION.............................................................................................................................................17
5.3 CONCLUSION.........................................................................................................................................18
5.4 RECOMMENDATION..............................................................................................................................19
APPENDIX I REFERENCE...............................................................................................................................20
APPENDIX II QUESTIONAIRE….....................................................................................................................21
APPENDIX III PROPOSED BUDGET…............................................................................................................22
APPENDIX IIV TIMEFRAME..........................................................................................................................23

v
 ABSTRACT
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent
hyperglycemia.it results from either impaired insulin secretion or impaired insulin efficacy. Is
broadly classified into three types by etiology and clinical presentation, type 1 diabetes, type 2
diabetes, and gestate onal diabetes (GDM (Aus. der Zeitschrift.2018). Type 2 diabetes is
emerging in Sudan and is associated with obesity. Deregulated lipid metabolism and
inflammatory states are suggested risk factors for cardiovascular disease, which is a leading
cause of diabetic death(Flagged et al., 2015). the prevalence of T2DM is steadily increasing
everywhere, most markedly in the world’s middle-income countries. China is experiencing the
world’s largest diabetes epidemic. The prevalence of T2DM in Mainland China has risen from a
low 0.67% in 1980 to an astounding 10.9% in 2013. International Diabetes Federation estimated
the number of Chinese people aged 20–79 years with diabetes to be at 114.4 million in 2017.3
identifying modifiable risk factors and reducing the prevalence of these factors is essential for
the prevention of T2DM. Dyslipidemia such as elevated triglycerides (TGs) or decreased high-
density lipoprotein cholesterol (HDL-C) is a common feature accompanying T2DM and
prediabetic states. There are several prospective studies that have demonstrated elevated blood
TG levels to increase the risk of diabetes, impaired glucose tolerance11 and impaired fasting
glucose. Some studies have shown that HDL-C is inversely associated with the incidence of
T2DM.Insulin resistance (IR) is a key risk factor for T2DM. The triglyceride to high-density
lipoprotein cholesterol (TG/HDL-C) ratio has been reported to be a surrogate marker of IR.this
might be a simple and reliable method to assess IR. However, only few prospective studies have
evaluated the association between the TG/HDL-C ratio at baseline and the incidence of T2DM.

v
 LIST OF TABLES

Table 4.1 gender of the respondents.........................................................................15

Table 4.2 age of the respondents...................................................................................15

Table 4.3 the marital status of the respondents................................................................16

Table 4.5 Are you employee?...............................................................................................16

Table 4.6 types of employees.............................................................................................17

Table 4.7 how long have you been diabetic patient?...........................................................18

Table 4.8 do you take any drugs of this disease?...............................................................19

Table 4.9 how long have you been taking this drug?.......................................................20

Table 4.10 what kind of food do eat mostly?.......................................................................21

Table 4.11. Do you do exercise?..........................................................................................21

Table 4.12 what kind of exercise do you do?.......................................................................22

Table 4.13 Do you smoke?...................................................................................................23

Table 4.14 Do you have any others, chronic disease?..........................................................24

Table 4.15 if yes have any others, chronic disease............................................................25

Table 4.16 triglyceride.......................................................................................................26

Table 4.17 CRP.................................................................................................................27

Table 4.18 HDL............................................................................................................28

Table 4.19 DURATION.............................................................................................29

i
 CHAPTER ONE
1.0 INTRODUCTION
This chapter deals with background of the study, problem statement, objectives of the study,
research questions, significance of the study, scope of the study and operational definitions.

1.1background

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent

hyperglycemia.it results from either impaired insulin secretion or impaired insulin efficacy. Is
broadly classified into three types by etiology and clinical presentation, type 1 diabetes, type 2
diabetes, and gestate onal diabetes (GDM (Aus. der Zeitschrift.2018). Type 2 diabetes is
emerging in Sudan and is associated with obesity. Deregulated lipid metabolism and
inflammatory states are suggested risk factors for cardiovascular disease, which is a leading
cause of diabetic death (Flagged et al., 2015). the prevalence of T2DM is steadily increasing
everywhere, most markedly in the world’s middle-income countries. China is experiencing the
world’s largest diabetes epidemic. The prevalence of T2DM in Mainland China has risen from a
low 0.67% in 1980 to an astounding 10.9% in 2013. International Diabetes Federation estimated
the number of Chinese people aged 20–79 years with diabetes to be at 114.4 million in 2017.3
identifying modifiable risk factors and reducing the prevalence of these factors is essential for
the prevention of T2DM. Dyslipidemia such as elevated triglycerides (TGs) or decreased high-
density lipoprotein cholesterol (HDL-C) is a common feature accompanying T2DM and
prediabetic states. There are several prospective studies that have demonstrated elevated blood
TG levels to increase the risk of diabetes, impaired glucose tolerance11 and impaired fasting
glucose. Some studies have shown that HDL-C is inversely associated with the incidence of
T2DM.Insulin resistance (IR) is a key risk factor for T2DM. The triglyceride to high-density
lipoprotein cholesterol (TG/HDL-C) ratio has been reported to be a surrogate marker of IR.this
might be a simple and reliable method to assess IR. However, only few prospective studies have
evaluated the association between the TG/HDL-C ratio at baseline and the incidence of T2DM.
(Liu et al., 2021).
Globally According to international diabetic federation (IDF), globally, from a total of 5 billion,
an estimated 463 million adults between the ages of 20–79 years (9.3%) have diabetes, and a
total of 4.2 million deaths due to it. More than three fourth of these people live in countries
considered to be low and middle income, with prevalence rate of (9.5% and 4%) respectively.
1
By the year

2
2030 it is projected worldwide that the number of patients with DM will increase and climb
578.4 million, about (2.26%) increase in the prevalence of DM to the current rate. More than 310
million 10.8% of diabetic patients live in urban settings, whereas almost 153 million live in rural
areas. Over the past three decades, globally the prevalence of DM has been gaining momentum
with an estimated 4.7% in the year 1980 to 8.5% in 2014. In 2019 China and India the two most
populous countries in the world) are the leading in the number of people living with DM (more
than 116 million and 77 million A recent report from over Fifty countries shows that 55% of
individuals living with DM, develop an end stage renal disease In western countries one fourth of
patients with T2DM develop diabetic nephropathy with recent study showing that diabetic
nephropathy is the single leading cause of end stage renal disease and replacement.
(Ogurtsova K,2015)
In Africa, Diabetes particularly affects low-income and middle-income countries in terms of
prevalence, mortality, and morbidity. More than 80% of people with diabetes live in developing
countries, where rapid cultural and social changes, including changes in lifestyle, aging
populations, increasing urbanization, dietary changes, and reduced physical activity, all
contribute to the dramatic increase in the epidemic of diabetes. The majority of people with
diabetes in low- income and middle-income countries are under 60 years of age.2 According to
recent estimates, diabetes accounts for 1.4 million cases with 7.7% prevalence and more than
25,000 diabetes- related deaths in Sudan. (Faggad et al., 2015)
In Somalia the frequency of diabetes mellitus in Somalia faces unique challenges in combating
the disease including lack of funding for non-communicable diseases, lack of availability of
studies and guidelines specific to the population, lack of availability of medications, differences
in urban and rural patients, and inequity between public and private sector health care. Because
of these challenges, diabetes has a greater impact on morbidity and mortality related to the
disease in sub- Saharan Africa, especially in Somalia than any other region in the world. (Abdul
Majid et al., 2019)

1.2 Problem statement

Type 2 diabetes mellitus (T2DM) is a progressive disease, characterized by insulin resistance and
ongoing loss of endogenous insulin secretion. More and more people are affected by T2DM in
recent years. It was reported that the overall prevalence of diabetes in the Chinese adult

3
population was estimated to be 11.6% and the prediabetes was 50.1% in 2013. T2DM is the
most common

4
form of diabetes for Chinese populations, which accounts for more than 90% of all diagnosed
diabetes mellitus cases. As insulin resistance is important in the pathogenesis of T2DM, it is
helpful to identify early insulin resistance. Triglyceride (TG) to high-density lipoprotein
cholesterol (HDL-C) ratio has been proposed as a simple marker of insulin resistance. The
potential utility of TG/HDL-C to detect insulin resistance was firstly reported by McLaughlin in
a Caucasian population. It is possible that given the racial variations in both TG and HDL-C
levels, the association between TG/HDL-C and insulin resistance is ethnicity-dependent. There
are limited evidences supporting that the ratio of TG/HDL-C is a surrogate marker of insulin
resistance in Chinese individuals. What’s more, few studies have been conducted in newly
diagnosed T2DM patients. Thus, this study focused on the plasma lipid profiles and explored the
association between TG/HDL-C and insulin resistance in Chinese patients with newly diagnosed
T2DM. (Ren et al., 2016). Dyslipidemia such as elevated triglycerides (TGs) or decreased high-
density lipoprotein cholesterol (HDL-C) is a common feature accompanying T2DM and
prediabetic states. There are several prospective studies that have demonstrated elevated blood
TG levels to increase the risk of diabetes, impaired glucose tolerance and impaired fasting
glucose. Some studies have shown that HDL-C is inversely associated with the incidence of
T2DM.Insulin resistance (IR) is a key risk factor for T2DM. The triglyceride to high-density
lipoprotein cholesterol (TG/HDL-C) ratio has been reported to be a surrogate marker of IR. This
might be a simple and reliable method to assess IR.(Zheng et al., 2020) .

1.2.1 Objective of this study

1.2.2 General of objective
Assessment of Triglycerides to High Density Lipoprotein Cholesterol Ratio and C- reactive
protein among Type 2 Diabetic at Somali Sudanese hospital.
1.3 specific of objective
1. To measure triglycerides and HDL, CRP among type 2 diabetic patient at Somali Sudanese
hospital
2. To find ratio between triglyceride and high-density Lipoprotein (HDL) at Somali Sudanese
hospital
3. To assess the relationship between triglyceride, HDL and C-reactive protein with duration of
type two diabetic patients at Somali Sudanese hospital

5
1.4 Research question
1. What triglycerides and HDL, CRP among type 2 diabetic patient at Somali Sudanese hospital?
2. What is ratio between triglyceride and high-density Lipoprotein (HDL)
at Somali Sudanese Hospital?
3. What is assess the relationship between triglyceride, HDL and CRP with duration type two
diabetic patients at Somali Sudanese hospital?

1.4.1 Scope of the study

This scope was concerned Triglycerides to High Density Lipoprotein Cholesterol Ratio and C -
reactive protein among Type 2 Diabetic at Somali Sudanese hospital.

1.4.2 Time of scope

This scope was beginning 6 December 2022 to 15 January 2023.

1.5 Geographical scope

This scope will caried out at Somali Sudanese hospital Hodan District in Mogadishu Somalia.

1.6 Significance of the study

This study would be useful for associations in the field of find study also NGOs or other donors’
agencies and international agencies operating Somalia. This study would be useful for
academicians, and community members. The study was also benefited by local community
because it greats conscious awareness of severity of particular problem and also urgency of the
need for solution. The study will also be useful for institution both public and private because it
makes them aware of existing issues and also proper ways to come up with a long-lasting
solution.

1.7 Operational key terms

Type two diabetes is common condition that causes the level of sugar (glucose) in the blood to
become too high.
C-reactive protein (CRP); test measures the level of C - reactive protein your blood.
Lipoprotein a group of soluble proteins that combine with and transport fat or other lipids in the
blood plasma.
Triglycerides any of group of lipids that are ester formed from one molecule of glycerol and
three molecules of one or more fatty acid.

6
Cholesterol is present in tissues and in plasma either as free cholesterol or as storage form
combined with along chain fatty acid as cholesteryl ester.
HDL; a Lipoprotein of blood plasma that is composed of a high proportion of protein with little
triglyceride and cholesterol that is correlated with reduced risk of atherosclerosis.

7
 CHAPER TWO

LITERATURE REVIEW

2.0 INTRODUCTION
Type 2 diabetes mellitus (T2DM) is characterized by dysregulation of carbohydrate, lipid and
protein metabolism, and results from impaired insulin secretion, insulin resistance or a
combination of both. Of the three major types of diabetes, T2DM is far more common
(accounting for more than 90% of all cases) than either type 1 diabetes mellitus (T1DM) or
gestational diabetes Over the past few decades, our understanding of the development and
progression of T2DM has evolved rapidly. Its main cause is progressively impaired insulin
secretion by pancreatic β-cells, usually upon a background of pre-existing insulin resistance in
skeletal muscle, liver and adipose tissue. Overt hyperglycemia is preceded by prediabetes1, 2 a
high-risk condition that predisposes individuals to T2DM development. Prediabetes is
characterized by any one of the following: impaired fasting glucose (IFG) levels, impaired
glucose tolerance (IGT) or increased glycated hemoglobin A1C (HbA1c) levels. Individuals with
IFG levels are characterized by fasting plasma glucose levels that are higher than normal but do
not meet the criteria for the diagnosis of diabetes. IGT is characterized by insulin resistance in
muscle and impaired late (second-phase) insulin secretion after a meal, whereas individuals with
IFG levels manifest hepatic insulin resistance and impaired early (first- phase) insulin secretion
Individuals with prediabetes have HbA1c levels between 5.7–6.4%; they represent
heterogeneous group with respect to pathophysiology and are clinically very diverse. Annual
conversion rates of prediabetes to T2DM range from 3% to 11% per year. (Balaji et al., 2014)
Its smallest and most dense lipoprotein particle, synthesized by liver and intestine. Discoidal or
spherical shape, Discoidal represent recent and most active form in removing excess cholesterol
from peripheral cell (Bishop et al.,2018). Plasma levels of high-density lipoprotein (HDLc)
cholesterol are strongly inversely associated with atherosclerotic CVD. 14 The molecular
regulation of HDL metabolism is not fully under stood, but it is influenced by several
extracellular lipase (Jin et al.,2002). there are many scientific studies prove the relationship
between the Low density HDLC and the cardiovascular disease in patients with diabetes mellitus
like (Golay et al.,1987), (Awadalla et al.,2018), (Elnasri and Ahmed.,2008) and others.
Alterations of HDLc in diabetes are probably based on the presence of insulin deficiency or,
more commonly, on
8
hyperinsulinemia and insulin resistance. HDLc (particularly the subfractionHDLc2)
concentration is regulated by two endothelial lipolytic enzymes, lipoprotein lipase and hepatic
lipase, both of which are insulin sensitive (Nikkila,1981).
The triglycerides: HDLc ratio recently used as predict subject at increased risk of developing
metabolic and cardiovascular complications. (Tommaso et al.,2013). Also, its prdictive for the
severity of CHD. It could predict in hospital_new onset heart failure incidents of CHD patients
(Yunke et al., 2014). HDLc levels are inversely related to plasma triglycerides levels and there is
a dynamic interaction between HDLc and triglycerides (TGs) rich lipoproteins in vivo
(Lamarche, 1999). The atherogenic link between high Triglycerides and HDLc-cholesterol is due
to higher plasma concentration of Triglycerides-rich; very low-density lipoprotein, that generates
small, dense LDL, during lipid exchange and lipolysis. This LDL particle accumulate in the
circulation and form small dense HDLc particles, which undergo accelerated catabolism, this
dosing the atherogenic circle (Protasio et al., 2008). The treatment of lipids disordered include
statin, one of the most powerful classes of agents for the treatment of cardiovascular diseases the
15 reductions in circulating serum lipid levels that were mediated by inhibition of liver 3-
hydroxy 3-methyl glutaryl coenzyme A (HMG-CoA) reductase (Lefer, 2002). Dietary
supplementation with soluble fiber, such as psyllium husk, oat bran, guar gum and pectin, and
fruit and vegetable fibers, lowers serum LDL cholesterol concentrations by 5 to 10 percent
(Knop,1999).
CRP is an ancient highly conserved molecule and member of pentraxin family of proteins,
secretes by liver in response to trauma, infection, inflammation (Do clos, 2000). Recent evidence
implicates inflammation in the pathogenesis of coronary heart disease; C reactive protein, a
plasma marker of inflammation, is a marker of CHD (Folsom et al.,2002).and others multiple
prospective studies now demonstrate that high sensitivity C reactive protein is a potent predictor
of future cardiovascular events at all level of low-density lipoprotein cholesterol (Ridker,2003).
Elevated HS-CRP was significantly correlate with electrocardiogram; defined coronary artery
disease (Thakur et al., 2011).

2.1 Ratio between triglyceride and high-density Lipoprotein (HDL)

Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio has been proposed as a

9
simple marker of insulin resistance. The potential utility of TG/HDL-C to detect insulin
resistance

1
was firstly reported by McLaughlin in a Caucasian population. Similar results were found in
different racial groups such as Korean. non-Hispanic Black and Mexican American However,
studies showed that TG/HDL-C might not be a marker of insulin resistance for African
populations. It is possible that given the racial variations in both TG and HDL-C levels, the
association between TG/HDL-C and insulin resistance is ethnicity-dependent. There are limited
evidences supporting that the ratio of TG/HDL-C is a surrogate marker of insulin resistance in
Chinese individuals. What’s more, few studies have been conducted in newly diagnosed T2DM
patients. Thus, this study focused on the plasma lipid profiles and explored the association
between TG/HDL-C and insulin resistance in Chinese patients with newly diagnosed T2DM the
ratio of triglyceride to high-density lipoprotein cholesterol levels (TG/HDL-C) was shown to be
associated with IR. However, those studies were mainly cross-sectional and did not reveal a
nonlinear relationship between TG/HDL-C and T2DM incidence (Liu et al.,2021). Triglyceride
(TG) to high-density lipoprotein cholesterol (HDL-C) ratio has been proposed as a simple marker
of insulin resistance. The potential utility of TG/HDL-C to detect insulin resistance was firstly
reported by McLaughlin in a Caucasian population. Similar results were found in different racial
groups such as Korean non-Hispanic Black and Mexican American. However, studies showed
that TG/HDL- C might not be a marker of insulin resistance for African populations. It is
possible that given the racial variations in both TG and HDL-C levels, the association between
TG/HDL-C and insulin resistance is ethnicity-dependent. There are limited evidences supporting
that the ratio of TG/HDL-C is a surrogate marker of insulin resistance in Chinese individuals.
What’s more, few studies have been conducted in newly diagnosed T2DM patients. Thus, this
study focused on the plasma lipid profiles and explored the association between TG/HDL-C and
insulin resistance in Chinese patients with newly diagnosed T2DM. (Elam et al.,2017).
Triglycerides (TG) and the triglyceride to high-density lipoprotein cholesterol concentration ratio
(TG/HDL-C) have been reported to be closely related to insulin resistance, and use of TG and
TG/HDL-C as surrogates for insulin resistance has been recommended. On the other hand, some
authors have emphasized interethnic differences in lipid profiles and insulin resistance, and
cautioned the use of lipid surrogates for insulin resistance. In fact, recent literature shows that
African Americans have more favorable lipid profiles than whites despite African Americans
being more insulin resistant. Therefore, the aim of our study was to examine how well insulin
resistance could be predicted

1
from TG and TG/HDL-C in a group of young, healthy African American and white participants.
(S. Kim-Dorner et al.,2015).

2.3 the relationship between triglyceride, HDL and CRP with duration type two diabetic
patients
Dyslipidemia such as elevated triglycerides (TGs) or decreased high-density lipoprotein
cholesterol (HDL-C) is a common feature accompanying T2DM and prediabetic states. There are
several prospective studies that have demonstrated elevated blood TG levels to increase the risk
of diabetes, impaired glucose tolerance and impaired fasting glucose. Some studies have shown
that HDL-C is inversely associated with the incidence of T2DM. Insulin resistance (IR) is a key
risk factor for T2DM. The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio
has been reported to be a surrogate marker of IR. This might be a simple and reliable method to
assess IR. However, only few prospective studies have evaluated the association between the
TG/HDL- C ratio at baseline and the incidence of T2DM. To our knowledge, there have been
only a 15-year prospective study in an urban community population and a rural cohort study that
examined whether the higher TG/HDL-C ratio at baseline is associated with the increase risk of
incident T2DM in Chinese people. It is worth noting that the majority of published studies on
this topic were based on a single measure of TG/ HDL-C ratio, failing to take into account the
potential effect of change in the ratios over time. Many covariate data such as TG, HDL-C and
blood pressure are collected regularly in longitudinal studies. They may fluctuate over time and
are commonly addressed as time-dependent (or time-varying) covariates in statistics. Not
accounting for time-dependent and cumulative average of the TG/ HDL-C ratio over time could
bias the true association between the TG/HDL-C ratio and the risk of T2DM. Thus, prospective
studies that evaluate the unbiased effect of the time-dependent TG/HDL-C ratio on the risk of
T2DM in the presence of time-varying confounders are essential. We took the opportunity of a
well-designed prospective study of Beijing Longitudinal Study of Aging (BLSA) with 25 years
of follow-up to investigate the association between time-dependent TG/HDL-C ratios and the
risk of T2DM incidence based on the longitudinal data. Furthermore, we also examined whether
a single measure of TG/HDL-C ratio at baseline or average TG/ HDL-C ratio during the follow-
up period was associated with the future risk of T2DM incidence. was implemented by the
Capital Medical University.25 To select a representative sample whose geographic distribution,
economic status, age and education were similar to those of the Beijing population older than 55

1
years, a three-stage

1
stratification-random clustering sampling method was conducted during cohort establishment. A
full description of the design and implementation of this cohort study has been described
previously. Briefly, 3257 community residents who were from the Xuanwu District (urban),
Daxing County (suburb, rural) and Huairou County (extended suburb, mountain), aged at least
55 years were invited to participate in 1992. A total of 2101 participants completed the
questionnaire assessments and physical examination of the first survey from July 1992 to August
1992. These participants were followed up in 1994, 1997, 2000, 2004, 2007, 2009, 2012 and
2017. In five
surveys (1992, 2000, 2009, 2012 and 2017), participants underwent physical examinations and
laboratory tests. The data used in this study were from this cohort implemented during the period
from 1992 to 2017. This study excluded participants with diabetes (a self-reported history of
T2DM or a fasting plasma glucose (FPG) concentration ≥7.0 mmol/L) at baseline. We also
excluded 395 individuals, who failed to complete the laboratory tests or had missing data for TG
levels or HDL-C levels at baseline. We further excluded two participants who died from type 1
diabetes and had no history of T2DM. Therefore, 1460 participants with complete data were
considered in the final analyses. This study was in accordance with the principles of the
Declaration of Helsinki. All participants provided their written informed consent before taking
part in this survey. (Zheng D, Li H, Ai F, et al.,2019).

2.4 RELATED STUDY

The Study Participants according to Serum TG/HDL-C. Of the 7,791 participants, 394 were
diagnosed with T2DM at 4 years of follow-up. The changing tendency of blood lipids and
TG/HDL-C through 4 years between T2DM patients. The mean age will 56:03±7:82 years, and
one-third (2,613, 33.54%) of the participants were male. The mean TG/HDL-C was 1:10± 0:62.
Participants with higher TG/HDL-C values were more likely to be male and smokers and to have
hypertension, stroke, hyperlipidemia, lower walking frequency, and a family history of T2DM.
In addition, serum TG/HDL-C was directly proportional to systolic and diastolic blood pressure,
BMI, waist circumference, hip circumference, presence of fatty liver, and the levels of alanine
aminotransferase, creatinine, total cholesterol, TGs, LDL-C, fasting plasma glucose, and
hemoglobin A1c, but inversely proportional to the HDL-C level. (Thakur et al., 2011).

1
 CHAPTER THREE
RESEARCH DESIGN

3.0 Overview

This chapter was concerning the following main ideas such as Research area, Research design,
Research population, Target population, Inclusion and Exclusion criteria, Sample size
determination, Sampling procedure, Research instrument methods, Data analysis, Ethical
consideration and Research limitation.
3.1 Study design
This study was be descriptive cross-sectional study because it’s easy to use as the information
collect from respondents and it’s not required to make re-investigation over a period of the study.
3.2 Study Area
This Study was conduct in Somalia Sudanese specialized hospital located in Banadir region
specially Hodan district Mogadishu-Somalia.
3.3 Target population
The target population of this study type 2 diabetes Mellitus patients attending at Somali
Sudanese specialized hospital for the period of the study.

3.4 Sample size

The sample size of this present study was be duration sample since we don’t know the number of
diabetic patients we shall meet at Somali Sudanese hospital during our study period, therefore
once we know the number of diabetic patients attending at Somali Sudanese specialized hospital
during our study period, later on we was use the solving formula to calculate our suitable sample
size if we needed.

1
3.5 Sampling procedure

The sampling technique uses in this study was non-probability sampling technique.
Nonprobability sampling is a method of sampling where the researcher intentionally chooses
whom to include in the study based on their ability to provide necessary data.

3.6 Research instrument

Questionnaire was suitable instrument to obtain information needed can easily described in
writing. Since the sample size is fairly large and there is limited time, questionnaire was have
considered ideal for collecting such data, is suitable tool for collect lot information over short
period of time. Self-developed questionnaire and close end questions was use in the study.

3.7 laboratory procedure:

approximately 3ml of vein puncture blood was draw in plain tubes these was then centrifuged at
3000rpm for 10minutes Spectrophotometer was employee in analyzing the total cholesterol and
triglyceride, HDL, C-reactive protein serum also taken and type 2 diabetes mellitus. We use
centrifuge, biochemistry Spectrophotometer: is device measures the intensity of electromagnetic
energy at each wavelength of light in a specified region.
3.8 Validity and reliability of the instrument
To establish the reliability of questionnaire the researcher’s used method of expertise judgment
as best method of reliability after the construction of the questionnaire. The researchers
approached supervisor and other experts those have great knowledge about the topic of this study
to ensure the reliability and validity of the researcher instrument. The sample technique and
procedure or mechanisms put in place made the study possible to insure the validity and
reliability as they kicked off the biasness in the research and the advice of experts: which clearly
made the research relevant, specific and logical. In addition, a pilot test was conducted 20
respondents in order to test and prove on the reliability of the questionnaire. To prove the
validity of the data collection instrument scale was used the validity relevance questionnaire and
the total number.

3.9 Data gathering procedure

This study was use primary data. This was collect from respondents in the area of study. Data
was collect using a pre-cod structured questionnaire for the survey, Close-end questions was use.

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The close-end questions are questions in which an all-possible answer was pre-specified
and the

1
respondents make the choice from the answers provide. Data collection was do by a face-to face
personal interview method. An informed interviewer visits each respondent. This is important
because it helping the respondent to understand the questions by interpreting them to fit the
respondents‟ understanding. This was done to ensure that the respondent.

3.10 Data analysis

This part was addressed, processing and analysis. The researchers was use to collect data
descriptive statistics to analysis primary data. Descriptive statistics refers to the use for
measuring of central tendencies such us mean, mediums, and modes and measurement of
dispersion such as range, quartile, standard deviations and variance to describe a group of
subjects. The data was collect from Somali Sudanese specialized hospital in Hodan district, edit,
collect and tabulate. Data was use manually enter in a statistical package for social analysis
(SPSS) spreadsheet then tabulated using the programmer and analyzing. Statistical package for
social science analysis (SPSS) is computer application that provides statistical analysis of a data.
It allows in-depth data access and preparation, analytical, reporting graphics and reporting tables.
3.11 Ethical considerations
Respect: The researcher was respect respondent’s privacy when entering their private sphere and
when asking questions.
Confidentiality: the researcher was guarantee maximum confidentiality for the participants.
Their information will only be used for the purpose of the study.
Freedom to participate: participants was be informed that they are free to participate. They was
also be informed that they have the right to withdrawal. Informed consent: consent was be
secured from the participants after fully informing the nature, potential risks and benefits of the
study.
3.12 Limitations of the study
The limitation may face the researcher during the study, here are some of the challenges that the
researcher encountered:
 Inadequate of internet access.
 Some respondents were refused answering the questionnaire.
 Financial problems Impact, due to unemployment of some researchers.
 Lack of enough time and fund to make the research study.
 Security problems.

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 Chapter four

Results and interpretation

4.0 introduction

This chapter presented data analysis and its interpretation after data collection analysis
was done by the use of SPSS result were indicated using the table of the charts.

Table 4.1 gender of the respondents.

Valid Frequency Percentage

Female 39 43

Male 51 56.7

Total 90 100.0

Table 4.1 shows that 39(43%) of the respondents were female, while 51(56.7%) of the
respondents were male. So, majority of the respondents were male and scored 56.7%.

Table 4.2 age of the respondents

Valid Frequency Percentage

18-25 5 5.6

26-34 29 32.2

35-44 41 45.6

45-65 15 16.7

Total 90 100.0

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Table 4.2 shows that 5(5.6%) of the respondents were 18-25, while 29(32.2%) of the respondents
were 26-34, while 41(45.6%) of the respondents were 35-44, while 15(16.7) of the respondents
were 45-65, so majority of the respondents were and scored 45.6%.

Table 4.3 the marital status of the respondents

Valid Frequency Percentage

Married 57 63.3

Single 13 14.4

divorced 16 17.8

widowed 4 4.4

Total 90 100.0

Table 4.3 shows that 57(63.3%) of the respondents were married, while 13(14.4%) of the
respondents were single while 16(17.8%) of the respondents were divorced, while 4(4.4) % were
widowed, so majority of the respondents were married and scored 63.3%.

2
Table 4.4 the level of education the respondents

Valid Frequency Percentage

Primary 26 28.9

Secondary 25 27.8

University 24 26.7

Informal 15 16.7

Total 90 100.0

Table 4.4 shows that 26 (28.9%) of the respondents were primary, while 25(27.8%) of the
respondents were secondary, while 24(26.7%) of the respondents were university, while
15(16.7%) of respondents were informal, so majority of the respondents were primary and
scored 28.9%.

Table 4.5 Are you employee?

Valid Frequency Percentage

Yes 62 68.9

No 28 31.1

Total 90 100.0

Table 4.5 shows that 62(68.9%) of the respondents were yes, while 28(31.1%) of the respondents
were no, so majority of the respondents were yes and scored 68.9%.

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Table 4.6 types of employees

Valid Frequency Percentage

Health worker 9 14.5

business man 22 35.5

Teacher 11 17.7

Other 20 32.3

Total 62 100.0

Table 4.6 shows that 9(14.5%) of the respondents were health worker, while 22(35.5%) of the
respondents were business man, while 11(17.7%) of the respondents were teacher, while
20(32.3%) of respondents were other, so majority of the respondents were other and scored
35.5%.

Table 4.7 how long have you been diabetic patient?

Valid Frequency Percentage

2 to 4 years 47 52.2

6 to 8 years 37 41.1

More than 10 years 6 6.7

Total 90 100.0

Table 4.7 shows that 47(52.2%) of the respondents were 2 to 4 years, while 37(41.1%) of the
respondents were 6 to 8 years. while 6(6.7%) of the respondents were more 10 years. so majority
of the respondents were 2 to 4 years and scored 52.2%.

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Table 4.8 do you take any drugs of this disease?

Valid Frequency Percentage

Yes 87 92.2

No 7 7.8

Total 90 100.0

Table 4.8 shows that 87(92.2%) of the respondents were yes, while 7(7.8%) of the respondents
were no, so majority of the respondents were yes and scored 92.2%.

Table 4.9 how long have you been taking this drug?

Valid Frequency Percentage

2 to 4 years 43 49.4

6 to 8 years 36 41.4

More than 10 years 8 9.2

Total 87 100.0

Table 4.9 shows that 43(49.4%) of the respondents were 2 to 4 years, while 36(41.4%) of the
respondents were 6 to 8 years. while 8(9.2%) of the respondents were more 10 years. so majority
of the respondents were 2 to 4 years and scored 49.4%.

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Table 4.10. Do you do exercise?

Valid Frequency Percentage

Yes 77 85.6

No 13 14.4

Total 90 100.0

Table 4.10. Shows that 77(85.6%) of the respondents were yes, while 13(14.4%) of the
respondents were no, so majority of the respondents were yes scored 85.6%.

Table 4.11 what kind of exercise do you do?

Valid Frequency Percentage

Gym 15 19.5

Walking 44 57.1

Playing football 18 23.4

Total 77 100.0

Table 4.11. Show that 15(19.5%) of the respondents were gym, while 44(57.1%) of the
respondents were walking, while 18(23.4%) of the respondents were playing football, so
majority of the respondents were walking and scored 57.1%.

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Table 4.12 Do you smoke?

Valid Frequency Percentage

Yes 15 16.7

No 75 83.3

Total 90 100.0

Table 4.12. Shows that 15(16.7%) of the respondents were yes, while 75(83.3%) of the
respondents were no, so majority of the respondents were yes scored 83.3%.

Table 4.13 How long have you been smoking?

Valid Frequency Percentage

1 to 3 years 7 46.7

4 to 7 years 8 53.3

Total 15 100.0

Table 4.13 shows that 7(46.7%) of the respondents were 1 to 3 years, while 8(53.3%) of the
respondents were 4 to 7 years, so majority of the respondents were 4 to 7 years and scored
53.3%.

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Table 4.14 How much packed do you smoke per day?

Valid Frequency Percentage

1 packet 55 61.1

2 to 3 packets 30 33.3

More than 4 packet s 5 5.6

Total 90 100.0

Table 4.14. shows that 55(61.1%) of the respondents were 1 packet, while 30(33.3%) of the
respondents were 2 to 3 packets, while 5(5.6%) of the respondents were more than 4 packets, so
majority of the respondents were 1 packet and scored 61.1%.

Table 4.15 Do you have any others, chronic disease?

Valid Frequency Percentage

Yes 59 65.6

No 31 34.4

Total 90 100.0

Table 4.15. Show that 59(65.6%) of the respondents were yes, while 31(34.4%) of the
respondents were no, so majority of the respondents were yes and scored 65.6%.

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Table 4.16 if yes have any others, chronic disease?

Valid Frequency Percentage

Heart disease 12 20.3

Hypertension 20 33.9

Hepatitis 12 20.3

Other 15 25.5

Total 59 100.0

Table 4.16 shows that 13(14.4%) of the respondents were heart disease, while 20(22.2%) of the
respondents were hypertation while 20(22.2%) of the respondents were hepatitis, while
37(41.1%) were other, so majority of the respondents were other and scored 41.1%.

Table 4.17 triglyceride

Valid Frequency Percentage

Desirable 44 48.9

Borderline 7 7.8

High line 39 43.3

Total 90 100.0

Table 4.17 shows that 44(48.9%) of the respondents were desirable, while 7(7.8%) of the
respondents were borderline while 39(43.3%) of the respondents were high line, so majority of
the respondents were desirable and scored 48.3%.

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Table 4.18 HDL

Valid Frequency Percentage

Desirable 23 25.6

Borderline 33 36.7

High line 34 37.8

Total 90 100.0

Table 4.18 shows that 23(25.6%) of the respondents were desirable, while 33(36.7%) of the
respondents were borderline while 34(37.8%) of the respondents were high line, so majority of
the respondents were high line and scored 37.8%.

Table 4.19 CRP

Valid Frequency Percentage

Reactive 53 58.9

None reactive 37 41.1

Total 90 100.0

Table 4.19. Show that 53(58.9%) of the respondents were reactive, while 37(41.1%) of the
respondents were none reactive, so majority of the respondents were yes and scored 58.9%.

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Table 4.20

T2DM P.VALUE Relationship

HDL 0.030 No sig

Triglyceride 0.001 sig

T2DM

CRP 0.076 No sig

Table 4.21 DURATION

DURATION P.VALUE Relationship

HDL 0.064 No sig

Triglyceride 0.001 sig

DURATION

CRP 0.080 No sig

Table 4.21 show Triglyceride, HDL and CRP and duration no Relationship.

2
 Chapter five

Findings, Discussion. Conclusions and Recommendation

5.1 Findings

According to table 4.1 shows that 39(43%) of the respondents were female, while 51(56.7%) of
the respondents were male. So, majority of the respondents were male and scored 56.7%.

Table 4.2 shows that 5(5.6%) of the respondents were 18-25, while 29(32.2%) of the respondents
were 26-34, while 41(45.6%) of the respondents were 35-44, while 15(16.7) of the respondents
were 45-65, so majority of the respondents were and scored 45.6%.

Table 4.3 shows that 57(63.3%) of the respondents were married, while 13(14.4%) of the
respondents were single while 16(17.8%) of the respondents were divorced, while 4(4.4) % were
widowed, so majority of the respondents were married and scored 63.3%.

Table 4.4 shows that 26 (28.9%) of the respondents were primary, while 25(27.8%) of the
respondents were secondary, while 24(26.7%) of the respondents were university, while
15(16.7%) of respondents were informal, so majority of the respondents were primary and
scored 28.9%.

Table 4.5 shows that 62(68.9%) of the respondents were yes, while 28(31.1%) of the respondents
were no, so majority of the respondents were yes and scored 68.9%.

Table 4.6 shows that 9(14.5%) of the respondents were health worker, while 22(35.5%) of the
respondents were business man, while 11(17.7%) of the respondents were teacher, while
20(32.3%) of respondents were other, so majority of the respondents were other and scored
35.5%.

Table 4.7 shows that 47(52.2%) of the respondents were 2 to 4 years, while 37(41.1%) of the
respondents were 6 to 8 years. while 6(6.7%) of the respondents were more 10 years. so,
majority of the respondents were 2 to 4 years and scored 52.2%.

Table 4.8 shows that 87(92.2%) of the respondents were yes, while 7(7.8%) of the respondents
were no, so majority of the respondents were yes and scored 92.2%.

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Table 4.9 shows that 43(49.4%) of the respondents were 2 to 4 years, while 36(41.4%) of the
respondents were 6 to 8 years. while 8(9.2%) of the respondents were more 10 years. so majority
of the respondents were 2 to 4 years and scored 49.4%.

Table 4.10. Shows that 77(85.6%) of the respondents were yes, while 13(14.4%) of the
respondents were no, so majority of the respondents were yes scored 85.6%.

Table 4.11. Show that 15(19.5%) of the respondents were gym, while 44(57.1%) of the
respondents were walking, while 18(23.4%) of the respondents were playing football, so
majority of the respondents were walking and scored 57.1%.

Table 4.12. Shows that 15(16.7%) of the respondents were yes, while 75(83.3%) of the
respondents were no, so majority of the respondents were yes scored 83.3%.

Table 4.13 shows that 7(46.7%) of the respondents were 1 to 3 years, while 8(53.3%) of the
respondents were 4 to 7 years, so majority of the respondents were 4 to 7 years and scored
53.3%.

Table 4.14. shows that 55(61.1%) of the respondents were 1 packet, while 30(33.3%) of the
respondents were 2 to 3 packets, while 5(5.6%) of the respondents were more than 4 packets, so
majority of the respondents were 1 packet and scored 61.1%.

Table 4.15. Show that 59(65.6%) of the respondents were yes, while 31(34.4%) of the
respondents were no, so majority of the respondents were yes and scored 65.6%.

Table 4.16 shows that 13(14.4%) of the respondents were heart disease, while 20(22.2%) of the
respondents were hypertation while 20(22.2%) of the respondents were hepatitis, while
37(41.1%) were other, so majority of the respondents were other and scored 41.1%.

Table 4.17 shows that 44(48.9%) of the respondents were desirable, while 7(7.8%) of the
respondents were borderline while 39(43.3%) of the respondents were high line, so majority of
the respondents were desirable and scored 48.3%.

Table 4.18 shows that 23(25.6%) of the respondents were desirable, while 33(36.7%) of the
respondents were borderline while 34(37.8%) of the respondents were high line, so majority of
the respondents were high line and scored 37.8%.
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Table 4.19. Show that 53(58.9%) of the respondents were reactive, while 37(41.1%) of the
respondents were none reactive, so majority of the respondents were yes and scored 58.9%.

5.2 Discussion

T2DM is a chronic metabolic disorder characterized by insufficient insulin production or IR

caused by other factors. The chronic hyperglycemia of diabetes is associated with long-term
damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart,
and blood vessels. In this cohort study, TG/HDL-C were shown to be associated with an elevated
risk of T2DM, independent of age, sex, body mass index, histories of hypertension, tumor,
stroke, and coronary heart disease, smoking status, alcohol intake, LDL-C, strenuous activity,
education level, and family histories of T2DM and tumors. We showed a nonlinear relationship
between serum TG/HDL-C and risk of T2DM; in that, the risk of T2DM after 4 years increased
significantly with an increase in TG/HDL-C when the ratio was less than 1.76 or 1.50, depending
on the variables adjusted. High TG and low HDL-C levels are known to be associated with
insulin resistance and T2DM and cardiovascular diseases (CVDs). In addition, they have been
explored to be used for insulin resistance, but the discriminatory power of single TG or HDL-C
was poor, and TG/HDL- C was a stronger risk factor. This is similar to the results of Korean
studies got an 0.73 area of TG/HDL-C ROC in overweight/obese women, which was a little
larger than ours. Although both of us studied on Chinese populations, distinct physical or health
condition was the main difference. Giannini et al. used the hyper insulinemic-euglycemic clamp
data as the gold standard of insulin sensitivity, the evaluation of TG/HDL-C was significant for
the whole cohort regardless of ethnicity and sex (0.752 ± 0.042, P < 0.00.

5.3 Conclusions

Type 2 diabetes mellitus (T2DM) is characterized by dysregulation of carbohydrate, lipid and

protein metabolism, and results from impaired insulin secretion, insulin resistance or a
combination of both. Of the three major types of diabetes, T2DM is far more common
(accounting for more than 90% of all cases) than either type 1 diabetes mellitus (T1DM) or
gestational diabetes Over the past few decades, our understanding of the development and
progression of T2DM has evolved rapidly. The TG–to–HDL cholesterol ratio may be related to
the processes involved pathophysiology and relevant with regard to the risk of clinical vascular

3
disease. It may be suitable

3
for the selection of patients needing an earlier and aggressive treatment of lipid abnormalities.
CRP measurement is independently associated with short-term mortality risk in type 2 diabetic
individuals, even in normoalbuminuric subjects and in those without a previous diagnosis of
CVD.

TG/HDL-C was positively associated with diabetes risk. In our study, for every increase in
TG/HDL-C quintile, the risk of T2DM after 4 years was 1.60 or 1.49 depending on the variables
adjusted. In addition, a nonlinear relationship between TG/HDL-C and T2DM incidence was
found in our cohort study. The inflection point of TG/HDL-C was 1.76 or 1.50, depending on the
variables adjusted. When the TG/HDL-C was less than 1.76 or 1.50, the ORs (95% CI) were
2.41 (1.82–3.18) and 2.50 (1.70–3.67), respectively. When the TG/HDL-C was greater than 1.76
or 1.50, there was no statistical difference in the change in OR.

5.4 RECOMMENDATION

From the results of this study, it’s recommended that:

TGs: HDLc ratio and CRP can be used routinely for type2 diabetic patients to assess atherogenic
index to avoid the complications that may suddenly happen.
The examine more sample size with different target population to get much more reliable.
Physical activity is an important part of managing your blood glucose level and staying healthy.
Being active has many health benefits.
You may need to check your blood glucose level before, during, and right after you are
physically active.
The researchers need more time.

3
 REFERENCE
Faggad, A. S., & Abdalla, B. E. (2015). C-reactive protein is associated with low-density
lipoprotein cholesterol and obesity in type 2 diabetic Sudanese. 427–435.
Liu, H., Yan, S., Chen, G., Li, B., Zhao, L., Wang, Y., Hu, X., Jia, X., Dou, J., Mu, Y., Wen, J.,
& Lyu, Z. (2021). Association of the Ratio of Triglycerides to High-Density Lipoprotein
Cholesterol Levels with the Risk of Type 2 Diabetes : A Retrospective Cohort Study in
Beijing. 2021.
Zheng, D., Li, H., Ai, F., Sun, F., Singh, M., Cao, X., Jiang, J., He, Y., Tang, Z., & Guo, X.
(2020). Association between the triglyceride to density lipoprotein cholesterol ratio and the
risk of type 2 diabetes mellitus among Chinese elderly : the Beijing Longitudinal Study of
Aging. 1–9. https://doi.org/10.1136/bmjdrc-2019-000811
Made Junior Rina Artha, I. (2019), Bhargah, A., Dharmawan, N. K., Pande, U. W., Triyana, K.
A., Mahariski, P. A., Yuwono, J., Bhargah, V., Putu Yuda Prabawa, I., Manuaba, I. B. A.
P., & Ketut Rina, I. (2019). High level of individual lipid profile and lipid ratio as a
predictive marker of poor glycemic control in type-2 diabetes mellitus.
Balaji, A., Suhas, B., Ashok, M., & Mangesh, T. (2014). Serum Alanine Transaminases and
Lipid Profile in Type 2 Diabetes Mellitus Indian Patients. Journal of Research in Diabetes,
2013(2013)(Yang et al., 2022).

3
Section A. SOCIO-DEMOGRAPHIC CHARACTERISTICS
Please tick in the bracket of one of the answers

1. Gender

1. Female

2. Male

2. Age

1. 18-25
2. 26-34
3. 35-44
4. 45-65
3. Marital status:
1. Married

2 single
3. Divorced
4. Widowed
4. Level of Education:
1. Primary
2. Secondary
3. University
4. informal
5. Are you employee?
1. Yes
2. No
6. Type of employee?
1 Health worker
2 Businessman
3 Teacher

3
 4 other
SECTION B: PATIENT QUESTIONS
1: How long have you been type two Diabetic patient?
A: 2 to 4 years
B: 6 to 8 years
C: more than 10 years
2: do you take any drugs for this disease?
A: Yes B: No
3: How long have you been taking this drug?
A: 2 to 4 years
B: 6 to 8 years
C: more than 10 years
4: Do you do exercise?
A: Yes B: No
5. what kind of exercise do you do?
A: Gym
B: walking
C: playing foot ball
6: do you smoke?
A: yes B: No

7.how long have you been smoking?

A: 1 to 3 years B: 4 to 7 years
8: how much packed do you smoke per day?
A: 1 packet
B: 2 to 3 packets
C: more than 4
9: do you have any others chronic disease?

3
 A: yes B: No
10: if you what is your other chronic disease?
A: heart disease
B: hypertension
C: hepatitis D: other

3
 APPENDIX III PROPOSED DUDJET

FINDING CATEGORY DOLLAR US$

COMPUTER AND INTERNET 15$

TRAVALING 18$

TRANSPORTATION EXPENSES

AIR TIME ON PHONES 15$

SUPPLYING QUESTIONNAIRE 8$
COLLECTION OF 15$
QUESTIONNAIRES OTHERS
8$

RESEACH PREPARATIONS 13$

PHOTOCOPY 15$

TOTAL 107$

3
 Appendix IV Time Frame

Activity Sept. Oct Nov Dec Jan

Topic
selection
Topic
s approval
Supervisor
nomination

Proposal
writing

Proposal
submission