Hamza Alasbily, Siham Ali Abbas, Adnan Asheibi, Abeer Albarasi, Abedalhameed Karim, Fatma Boshahma

Abstract. Summary. Introduction. In patients with type 2 diabetes (T2D), clinical features and cardiometabolic risk profiles may differ between sexes, potentially influencing disease expression and vascular risk stratification. This study aimed to evaluate whether the association between glycated hemoglobin (HbA1c) and atherogenic lipid markers differs by sex and to formally test sex-based interaction effects in patients with T2D. Methods. A retrospective observational study was conducted at the Benghazi Diabetes Center between June and September 2025, including 286 patients (158 females and 128 males). Demographic and clinical data – age, sex, HbA1c, diabetes duration, renal function, low-density lipoprotein (LDL), high-density lipoprotein (HDL), very-low-density lipoprotein (VLDL), total cholesterol (TC), and triglycerides (TG) – were analyzed. Statistical analyses were performed using SPSS, version 27. Baseline comparisons were performed using the Mann-Whitney U test and chi-square tests. Independent predictors were evaluated using multivariable linear regression, including an interaction term between HbA1c and sex to assess effect modification. A two-sided p-value <0.05 was considered statistically significant. Results. The mean HbA1c level was 7.72 ± 1.30%. Females had significantly higher HDL (p <0.001) and TC (p = 0.007) levels compared with males, demonstrating baseline sex-related differences in lipid distribution. In females, HbA1c correlated with LDL (r = 0.20, p = 0.01) and VLDL (r = 0.28, p = 0.026). In males, HbA1c correlated with LDL (r = 0.32, p <0.001) and TC (r = 0.26, p = 0.003). In multivariable models adjusted for demographic and clinical confounders, no significant interaction between HbA1c and sex was observed. HbA1c remained an independent metabolic correlate of LDL (β = 0.370, p = 0.008) and TC (β = 0.357, p = 0.005). Discussion. Although baseline lipid profiles demonstrated sexrelated dimorphism, the relationship between HbA1c and key atherogenic lipid markers was comparable across sexes in this cohort. These findings support the relevance of glycemic control in lipid risk assessment while indicating no evidence of sex-based effect modification.
Key words. Type 2 diabetes, glycated hemoglobin (HbA1c), dyslipidemia, sex factors, sex differences.