| Objective To explore the relationship between non-traditional lipid parameters and glucose variability (GV) parameters and bone mineral density (BMD) and concurrent carotid atherosclerosis (CAS) in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods We enrolled 150 newly-diagnosed T2DM patients in the Tianjin Baodi Hospital (from January 2022 to January 2025). The patients were stratified into osteoporosis (OP) and non-OP groups by BMD T-scores. We compared non-traditional lipid parameters [total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)/HDL-C, plasma atherosclerotic index (AIP), lipoprotein combined index (LCI), residual cholesterol (RC)] and GV parameters [time in range (TIR), mean amplitude of glycemic excursions (MAGE), largest amplitude of lycemic excursions (LAGE)] between the two groups, and analyzed their correlations. Patients were further categorized by coronary artery stenosis (CAS) presence into CAS and T2DM-only group. Comparative analyses was performed to identified the risk factors. ROC curves were evaluated. Results The OP group showed elevated TC/HDL-C, LDL-C/HDL-C, AIP, LCI, MAGE, and LAGE compared to controls (P<0.05). These parameters inversely correlated with BMD T-scores (P<0.05). CAS patients had longer diabetes duration, higher lipid/GV indices, and lower TIR than T2DM-only cases (P<0.05). AIP, LCI, MAGE, and LAGE independently predicted CAS comorbidity (P<0.05). Their individual AUCs for CAS prediction were 0.791, 0.790, 0.730, and 0.764, respectively, improving to 0.924 when combined (P<0.05). Conclusion The non-traditional lipid parameters (AIP, LCI) and glycemic variability metrics (MAGE, LAGE) show significant associations with bone mineral density and concomitant coronary artery stenosis in newly-diagnosed T2DM patients, serving as valuable indicators for CAS risk assessment. |