Incidence of gestational diabetes and inequalities in adverse pregnancy outcomes in England: contemporary, cross sectional observational study of 2.7 million births.

Type 2 diabetes mellitus (T2DM) is a long-standing metabolic disorder arising from progressive failure of pancreatic β-cell function and deteriorating insulin action, culminating in chronic hyperglycemia and widespread disruption of carbohydrate, protein, and fat metabolism. It represents the predominant form of diabetes globally and exerts a considerable burden on healthcare systems due to its rising prevalence and wide-ranging systemic complications []. Among the numerous metabolic sequelae associated with T2DM, diabetic dyslipidemia ranks among the most frequently encountered and is increasingly recognized as a primary driver of cardiovascular morbidity and mortality []. Diabetic dyslipidemia is pathophysiologically distinguished by hypertriglyceridemia, suppressed HDL cholesterol concentrations, and a preponderance of small, dense LDL cholesterol particles. These aberrations in lipid homeostasis stem primarily from insulin resistance, which disrupts the normal regulatory mechanisms of lipid metabolism and fosters an atherogenic milieu. Specifically, impaired insulin signaling accelerates lipolysis within adipose tissue, releasing an excess of free fatty acids into systemic circulation. The liver subsequently absorbs these fatty acids, driving heightened synthesis of triglycerides and very-low-density lipoprotein (VLDL) particles. Concurrently, diminished lipoprotein lipase activity compromises the catabolism of triglyceride-laden lipoproteins, compounding dyslipidemia []. Collectively, these disturbances markedly elevate the risk of cardiovascular disease and related metabolic complications in affected individuals []. The global burden of diabetic dyslipidemia has grown in parallel with rising rates of obesity and T2DM. Available evidence suggests that a majority of people with T2DM manifest at least one abnormal lipid parameter []. In India, this burden is particularly pronounced, with studies documenting lipid anomalies in upwards of 90% of diabetic patients []. Data drawn from the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study further confirms the high prevalence of dyslipidemia among Indian adults, with depressed HDL-C identified as the most common abnormality []. Additionally, Parikh et al. documented a high occurrence and distinctive pattern of diabetic dyslipidemia in Indian individuals with T2DM, with combined dyslipidemia emerging as the most prevalent lipid phenotype [].