Lipoproteins, diabeto-genicity, age and risk of diabetes mellitus death

To examine the clinical significance of a specific relationship between very low density lipoprotein (VLDL) and high density lipoprotein (HDL), namely their differential, in relation to Type 2 non-insulin dependent diabetes mellitus (NIDDM).

The study subjects were 300 female and 300 male patients of doctors in city and rural New South Wales referred for lipid studies. Their clinical notes suggested a relationship of VLDL-HDL to diabetes mellitus (DM) and it was therefore hypothesised that this expression is a functional measure of diabeto-genicity.

By incorporation of age, a calculated measure of risk of overt DM and consequent death can be derived. This is confirmed by comparing the age incidence of this risk function with the age incidence of death attributed to DM in the Australian population to give a simple linear correlation. The principal conclusion is drawn from a mathematical model of the population incidence of DM in terms of VLDL, HDL and age.

From this model springs the inference that NIDDM is a cumulative dyslipidaemia-over-time process. If this inference is correct, NIDDM can properly be viewed as a societal disease of which all run a measurable risk that increases with age and from which all will die in the long term who do not die sooner from another cause.

The implications for public health are the ability to identify the individuals at raised risk before DM becomes symptomatic by lipoprotein screening, and the ability to lower risk of DM over the whole population by preventive measures with increased longevity for all.