Associations between high cholesterol and insulin sensitivity in diabetic versus non-diabetic among young adults in Lephalale, Limpopo Province, South Africa

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Background: The rising global burden of diabetes mellitus and associated metabolic disorders disproportionately affects low and middle-income countries, with dyslipidemia being a key contributor to cardiovascular risk in insulin-resistant individuals. Limited data exist on population-specific associations between cholesterol levels and insulin sensitivity among young adults in transitioning African communities. Methods: This cross-sectional study analyzed 781 young adults (18-29 years) from the Ellisras Longitudinal Study in Lephalale, South Africa. Participants were stratified by diabetic status using ADA criteria. Fasting blood samples assessed glucose, insulin (HOMA-IR), and lipid profiles. Multivariable linear regression evaluated cholesterol-HOMA-IR associations, adjusted for confounders. Results: Diabetics (n=169) showed significantly higher total cholesterol (5.1 vs. 4.3 mmol/L), LDL-C (3.2 vs. 2.6 mmol/L), triglycerides (1.8 vs. 1.1 mmol/L), and lower HDL-C (1.0 vs. 1.2 mmol/L) than non-diabetics (all p<0.001). Dyslipidemia prevalence was 2-3 times higher in diabetics (e.g., 52.7% vs. 23.2% for high total cholesterol). HOMA-IR correlated positively with total cholesterol (β=0.42, p<0.001), LDL-C (β=0.38, p<0.001), and triglycerides (β=0.47, p<0.001), and inversely with HDL-C (β=-0.51, p<0.001). Conclusion: Young diabetic adults in Lephalale exhibit pronounced dyslipidemia and insulin resistance, with strong lipid-HOMA-IR associations. Findings highlight the need for early metabolic screening and targeted interventions in transitioning African communities to mitigate future cardio metabolic risk.

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