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1. Assessment of Triglycerides to High Density Lipoprotein Cholesterol Ratio and C - reactive protein Among Type 2 Diabetic at Somali Sudanese Hospital in Mogadishu BY :   Names Abdikafi Hassan Mohamud ID No. 4087 Kowthar Ali Abdi ID No.4336 Farah Muhidin Ahmed ID No. 4210

2. Introduction/Background 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.

3. Cont.… 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).

4. Problem Statement Diabetes mellitus type 2 (T2DM) is a disease that worsens over time and is typified by persistent decrease of endogenous insulin production and insulin resistance. In recent years, T2DM has affected an increasing number of people. According to reports, in 2013, the estimated prevalence of diabetes and prediabetes in the adult Chinese population was 11.6% and 50.1%, respectively. Over 90% of instances of diagnosed diabetes mellitus in China are T2DM cases, making it the most frequent kind of the disease. Early identification of insulin resistance is beneficial since it plays a significant role in the pathophysiology of type 2 diabetes. One straightforward indicator of insulin resistance has been suggested: the ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C). TG/HDL-C's possible use in identifying insulin resistance. There is insufficient data to suggest that in Chinese people, the TG/HDL-C ratio serves as a proxy for insulin resistance.

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

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

7. SCOPE OF THE STUDY Content scope The study was conduct Somali Sudanese hospital. This hospital is located in Mogadishu, Somalia’s capital. The researchers was use this hospital because it is the place to treat the Type 2 Diabetic. The study seeks to assess Triglycerides to High Density Lipoprotein Cholesterol Ratio and C - reactive protein among Type 2 Diabetic at Somali Sudanese hospital. Geographical scope The study was conduct Somali Sudanese hospital. This hospital is located in Mogadishu, Somalia’s capital. Time scope The study was cover the information from September to December 2023.

8. Conceptual Frame Work Ratio between triglyceride and high-density Lipoprotein (HDL)   Relationship between triglyceride, HDL and CRP with duration type two diabetic Triglycerides, HDL and CRP among type 2 diabetic C-reactive protein among Type 2 Diabetic

9. Research Design Research 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. Study area This Study was conduct in Somalia Sudanese specialized hospital located in Banadir region specially Hodan district Mogadishu-Somalia. Target Population The target population of this research was 70 of Somalia Sudanese hospital staffs in Mogadishu Somalia. This is because the staff has the right information and knowledge.

10. SAMPLING FRAME No Name hospital Target Population Sample Size 1 Somali sudanees hospital 70 60

11. Sample Size Calculation sample size from the target population. Stratified sampling method used to classify the target population in to two strata. Using the Slovene’s formulae, the sample size was 60 as shown below;

12. Data collection techniques Data collection techniques Primary data was collect using structured questionnaires. The structured questionnaire was best suitable for its ability to easily collect data and it was easily analyse Relevant questions about the variables of the study was generate Data processing and analysis 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.

13. Results/findings In terms of Age results it showed that the age of respondents. Majority of the respondents 35(58%) were the age of 26-34 years following by 15(25%) were 45-65 years while the rest 18-25 years 10(17%) were the age of respondents, comparing to the previous study for this case which showed that many different ages like this were find out that the demographic and clinical characteristics of individuals diagnosed with pre-diabetes. the mean age of the participants was 50 years, with (64.51%) of them being male. while the median duration of follow-up was 2.95  years, during which (41.91%) participants reverted to normoglycemia .

14. Results/findings In terms of gender, the respondent’s majority of the respondents 45(75%), were male while the other 15(25%) who participated were female. The previous study indicated that, the incident of T2DM showed an upward trend in terms of the gender who whose TG/HDL-C ratio (P for trend < 0.01). were male in the context of that the number of gender of female were more than the males TG/HDL-C, we further reviewed the association of TG/HDL-C ratio and T2DM in different subgroups (men and women) followed the factors were also more different.  The current study showed that the educational level the majority of the respondents were primary level 20(33%) and the followed by 15 (25%) were secondary level while the other of the 15(25%) were Bachelor’s degree and the rest of 10 the respondents of educational level were No formal education

15. Results/findings In accordance with the previous study the educational level were mostly bachelor degree levels 48 (59%) p.values was 0.016 and the remaining were secondary leves in terms of the educational level that wast targeted by the study in 2021, in Ethiopia and sudan . Result Laboratory diagnosis were indicated that 35 (58%) were abnormal for the density lipoprotein cholesterol tests from the blood while the other rests of 25 (42%) were Normal with the Result of Laboratory diagnosis tests during the hospital. Overall the baseline, of other compared researches showed that 50% of men reported history of type 2 diabetes, and 48% reported personal history of hypertension; 2% had history family genetics.

16. Results/findings In terms of history of high triglycerides the respondents have indicated that heart disease are the most number one from retrieving the target populations of this study and the respondents 40 (66%) said yes when asked them that the Family history of high triglycerides or heart disease and followed by 20(34%) have said no for the asked questions during the data collections on the other issues of triglyceride level the most recent triglyceride level and they indicated that they are normal and followed by 25 (42%) responded that recent triglyceride level is Abnormal when asking the measurement of protein levels and the last the respondents were asked that the measurement of protein levels 30 (50%) said yes we measure while the 25(41%) said no we don’t measure and the rest 5(9%) said we have Never measure in terms of the findings.

17. Results/findings While comparing to the additional study that indicates a non-linear correlation was found between TG/HDL-C ratio and the risk of T2DM, and the slope of the curve decreased after the cutoff point of 2.54. Subgroup analysis revealed a stronger positive correlation among male individuals and those with body mass index <24 kg/m2, this study which made in Sudan Khartoum in 2014.

18. Results/findings On the other hand there was previous study for this case triglyceride level The high serum CRP concentration in diabetes reported in this study and by other authors could be due to an increase in adipose tissue mass that enhances cytokines production by adipocytes, significant increase in the mean concentration of LDL-C in patients than controls, being 137.71 ± 36.73 mg/dl and 122.47 ± 16.19 mg/dl for patients and controls, (P-value 0.000). Also, a significant increase in the mean of CRP concentration over the control value was seen, being 7.38 ± 4.08 mg/dl and 4.13 ± 4.08 mg/dl for patients and controls respectively, (P-value 0.000).

19. Conclusion 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 disease.

20. Recommendations TGs: HDLc ratio and CRP can be used routinely for type2 diabetic patients to assess atherogenicindex 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 physicallyactive . It is needed to further research about on this Combining type 2 diabetes and prediabetes with dyslipidemia , which is defined by elevated triglycerides (TGs) or decreased HDL- C (high-density lipoprotein cholesterol), is common. Numerous prospective studies have connected elevated blood TG levels to lower glucose tolerance, poor fasting glucose, and an increased risk of diabetes.

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