Prevalence and Factors Associated With Dyslipidemia Among Adults With Type 2 Diabetes: Insights From the National Health and Nutrition Examination Survey (NHANES) 2009-2018

Background and objective Dyslipidemia is an atherogenic comorbidity common in type 2 diabetes and a major driver of cardiovascular events. This study aimed to examine the prevalence and factors associated with dyslipidemia (sociodemographic and clinical, such as waist circumference, blood pressure, smoking, BMI, and medication status) among U.S. adults with type 2 diabetes based on nationally representative data from the National Health and Nutrition Examination Survey (NHANES) 2009-2018. Methods We conducted a cross-sectional analysis of pooled NHANES 2009-2018, including adults aged ≥20 years with type 2 diabetes (n = 14,885; weighted N = 143,669,987). Dyslipidemia was defined by standard lipid thresholds. Survey weights, clusters, and strata were used; survey-adjusted t-tests and Rao-Scott F-tests were employed to compare groups. Multivariable survey logistic regression was utilized to estimate adjusted odds ratios (aOR) for key sociodemographic and clinical factors. Results Dyslipidemia was highly prevalent among adults with type 2 diabetes. Adjusted models showed older age (aOR per year: 1.01; p<0.001), female sex (aOR: 1.61; 95% confidence interval (CI): 1.44-1.79), greater waist circumference (aOR per cm: 1.03; 95% CI: 1.02-1.03), higher diastolic blood pressure (BP) (aOR per mmHg: 1.02; 95% CI: 1.01-1.02), and current smoking (aOR 1.34; 95% CI 1.17-1.53) were associated with higher odds. BMI and systolic BP were not significant. Non-Hispanic White and Non-Hispanic Black adults had lower adjusted odds than Mexican Americans. Conclusions Dyslipidemia remains a common comorbidity in adults with type 2 diabetes, shaped by both biological and social factors. Targeted, multidimensional interventions are required to address these disparities and reduce cardiovascular risk in this vulnerable population.