This is the first large epidemiological report in Somalia that focuses on the distribution of diabetic dyslipidemia, as well as the clinical and demographic characteristics of T2DM. Our study's main findings were as follows; (i) diabetes was poorly controlled, and accordingly, rates of diabetic dyslipidemia were extremely high, (ii) atherogenic dyslipidemia, which is important in the pathophysiology of cardiovascular disease, was also prevalent (24.8%), (iii) The dominant component of the dyslipidemia patterns was high LDL-C, which has a proven atherogenic effect, (iv) various dyslipidemia patterns were found to be associated with age, gender, BMI, central obesity, spot urine proteinuria, FBG, poor glycemic control, creatinine, and Hs-CRP.
Some studies conducted in countries, where Somalis live as refugees (Finland and the United States-based) where Somalis live as refugees (Finland and the United States-based), have found higher rates of obesity, sedentary lifestyle, diabetes, hypertension, and hyperlipidemia, all of which are cardiovascular risk factors [10, 11, 13]. For example, in a study of 1007 participants, high prevalence rates of obesity (68%), dyslipidemia (18.1%), prediabetic status (21.3%), hypertension (17%), and DM (12.1%) were reported among Somali refugees . Diabetes, obesity, and dyslipidemia rates were found to be significantly higher in Somalis than in other ethnic groups in another study comparing Somali refugees to Middle Eastern and Russian refugees . Our results have suggested that adult Somali inhabitants with T2DM have poor glycemic control and a higher incidence of dyslipidemia subgroups. Due to the country’s protracted civil war, the inability to provide appropriate treatment and follow-up for chronic diseases has resulted in a disregard for the importance of education, social awareness, and lifestyle changes. It should also be acknowledged that poverty and war are serious public health issues that have a negative impact on treatment and survival outcomes [18,19,20].
We have found the mean HbA1c value of 9.7 ± 2.2, which is far from the current recommended target levels for diabetes regulation . Moreover, females had nearly twice the rate of T2DM as males (66.5% vs. 33.5%). This finding is consistent with previous research revealing that women have higher prevalence rate of diabetes, particularly in third-world countries [22, 23]. This gender disparity against women could be attributed to the following reasons; (a) receiving less education due to religious and socio-cultural differences, (b) taking less advantage of healthcare opportunities, (c) Living apart from social life, not being conscious of health, self-care, follow-up, and treatment options, and thereby being more vulnerable to environmental factors.
In our investigation, the rate of total dyslipidemia among T2DM patients was found to be enormously high (92.8%). This was, however, close to the proportions of nations with similar degrees of development in the available literature. The rate, for example, was reported as 95% in Tanzanian study  and 89% from South Africa . Another study from Nigeria found the rate to be 69.3% . On the contrary, the frequency of dyslipidemia was relatively low in studies from industrialized nations, such as the United States and the United Kingdom [27, 28]. The present study has demonstrated that the frequency of dyslipidemia is impacted by regional socioeconomic conditions, the failure to implement comprehensive health policies, and insufficient follow-up and treatment, as is the case with many chronic illnesses. However, we consider that the poor health implications of many chronic diseases in nations, such as Somalia, which has long had insufficient health infrastructure for several reasons, are avoidable.
Cigarette consumption among Somalis is low, but men consume significantly more than women, which could be attributed to societal norms and religious beliefs . Smoking women, for instance, are stigmatized in Somali society . Furthermore, the current smoking rate among Somali youth in the United States has been reported to be 4.7%, which is similar to our findings .
Atherogenic dyslipidemia, which includes hypertriglyceridemia, low HDL-C, and high LDL-C, is linked to the development of microvascular and/or macrovascular disease, as well as poor cardiovascular outcomes . In the multicenter ACCORD trial, the prevalence of atherogenic dyslipidemia was found to be 17%, compared to 24.8% in the present study . Our study’s considerably greater prevalence of atherogenic dyslipidemia may be connected to poor blood glucose control and obesity. These findings add to our understanding of the link between atherogenic dyslipidemia and impaired glucose control in T2DM patients .
In the present research, the most often diagnosed subgroups of dyslipidemias were high non-HDL-C (82.8%), followed by high LDL-C (72.6%), high TC (60.2%), and low HDL-C (53.5%), with hypertriglyceridemia being the least common (47.3%). These results are in line with the few reports undertaken in several African nations [23, 35, 36]. Other studies from the region [36, 37] have found LDL-C dominance in combined dyslipidemias. However, the distributions of dyslipidemia patterns in diabetic individuals have varied between publications. These differences may be related to the research populations' geographical ethnic/genetic variety, dyslipidemia definitions, study methodology, and degree of glycemic control. LDL-C has so distinguished itself as a more atherogenic and powerful cardiovascular risk factor than other dyslipidemia components. As a result, LDL-C is still the primary target of lipid-lowering medication . In our study, such a high prevalence of dyslipidemia in patients with T2DM is not coincidental; it is referred to as diabetic dyslipidemia. Although the exact mechanism of dyslipidemia in T2DM patients is uncertain, insulin resistance may impair lipoprotein lipase activity, which is thought to be crucial in the onset of diabetic dyslipidemia. It may also cause a delay in the clearance of triglyceride-rich lipoproteins, thereby resulting in higher levels of LDL-C, TG, and lower levels of HDL-C . Because of the high LDL-C rates in both isolated and combined dyslipidemia patterns, we should underline the importance of prescribing statins as the primary treatment choice in our study.
The present study contains several drawbacks. First off, although being conducted in the best-equipped and largest institution in Somalia, the research does not have a design that is representative of the entire nation. Second, since the study was cross-sectional, a causal connection could not be proven. Third, there is a lack of knowledge on factors including the ratio of rural to urban areas, educational attainment, physical activity, length of DM, and alcohol use that may be linked to diabetic dyslipidemia. Another significant shortcoming is the country’s present economic position, which makes it difficult to study additional in-depth laboratory tests, such as apoproteins, lipoprotein(a), and lipoprotein-associated phospholipase A2, which may be connected to dyslipidemia.