Lean and Obese Patients with Newly Diagnosed Type 2 Diabetes Show High Atherogenic Risk: JAPI Study
A recent prospective comparative study found that newly diagnosed patients with Type 2 Diabetes Mellitus (T2DM), whether presenting as obese or lean, face a significant threat from increased atherogenic risk as critical metrics like the Atherogenic Index of Plasma (AIP) reached 0.7 and 0.6 respectively—drastically exceeding the 0.2 safety threshold—as a recent study published in the Journal of The Association of Physicians of India in March 2026 has shown.
As the global incidence of Type 2 Diabetes Mellitus continues to rise alongside increasing adiposity, previous investigations by Edelbert Anthonio Almeida and colleagues have previously compared general metabolic profiles in these cohorts, yet a clinical gap remains regarding the use of nontraditional lipid ratios in individuals who have not yet initiated medication; consequently, the current research team from the University College of Medical Sciences and GTB Hospital, Delhi, aimed to compare atherogenicity across newly diagnosed obese and lean patients using specialized lipid indices.
The prospective comparative study, conducted at a tertiary care facility in Delhi, evaluated 60 newly diagnosed, treatment-naïve subjects stratified into obese (Body Mass Index [BMI] ≥ 25 kg/m²) and lean (BMI < 18.5 kg/m²) cohorts based on Asia-Pacific guidelines, where researchers analyzed blood samples collected after a 12-hour fast to measure glycemic parameters and Fasting Lipid Profiles (FLP); patients with pre-existing hepatic, renal, or thyroid disorders, as well as pregnant women, were specifically excluded to ensure the primary assessment of metabolic markers precisely reflected the initial disease state.
Key Clinical Findings of the Study Include:
Significant AIP Elevation: The study noted that the atherogenic index of plasma was significantly higher in obese patients compared to lean ones (0.7 vs. 0.6, p = 0.006), serving as a sensitive indicator for future coronary complications.
Surpassed Cholesterol Cutoffs: Researchers observed that the Total Cholesterol (TC) to High-Density Lipoprotein Cholesterol (HDL-C) ratio reached 6.7 in obese subjects and 5.9 in lean subjects, both surpassing the recommended 3.5 clinical threshold.
Inverse Glycemic Trends: The investigation found that lean patients exhibited significantly worse glycemic control, with a mean Glycated Hemoglobin (HbA1c) of 11.5% compared to 9.42% in the obese cohort.
High Proatherogenic Potential: The Low-Density Lipoprotein Cholesterol (LDL-C) to High-Density Lipoprotein Cholesterol ratio was found to be 4.8 in the obese group and 4.0 in the lean group, both exceeding the sensitive predictor threshold of 2.517.
Disparate Fat Composition: The study confirmed that the percentage of body fat was significantly higher in obese patients at 35.9% compared to 22.1% in the lean group, highlighting the distinct physical characteristics of these metabolic phenotypes.
The results suggest that while cardiovascular risk is more pronounced among obese individuals due to higher lipid levels, lean patients also possess a substantial risk, as evidenced by mean Non-High-Density Lipoprotein Cholesterol (Non-HDL-C) values of 163.3 mg/dL and 152.8 mg/dL in the obese and lean groups, respectively.
Thus, the study concludes clinicians should consider the aggressive management and control of plasma lipids for all diabetic patients to effectively lower the high cardiovascular risk associated with the disease, regardless of their body mass index.
While these findings are limited by a relatively small sample size and the absence of age-matched healthy controls, they highlight an attractive opportunity for future research to further clarify the specific mechanisms of cardiovascular risk in these distinct patient populations.
Reference
Almeida EA, Mehndiratta M, Kirubalenin SP, et al. Atherogenic Indices in Newly Diagnosed Obese and Lean Patients of Type 2 Diabetes Mellitus: A Comparative Study. J Assoc Physicians India 2026;74(3):14–16.
