Endocrine Abstracts

Diabetes mellitus (DM) is associated with significant morbidity and mortality despite steadily improving standards of care. Coronary heart disease (CHD) is by far the most common cause of death in individuals with diabetes.

A characteristic pattern, termed diabetic dyslipidemia, consists of specifically mild to marked elevation of triglyceride-rich lipoproteins (VLDLs) and VLDL remnants concentrations and low levels of HDL-C. Raised serum triglycerides and low HDL-C often precede the onset of T2DM for many years. In addition, LDL particles are converted to smaller, perhaps more atherogenic, lipoproteins termed ’small-dense LDLs’.

Different mechanisms are responsible for the development of dyslipidemia in individuals with diabetes. Defects in insulin action and hyperglycemia could lead to dyslipidemia in patients with diabetes. In the case of T2DM, the obesity/insulin-resistant state that is at the basis of the development of this disease can in itself lead to lipid abnormalities independently of hyperglycemia. In poorly controlled T1DM hypertriglyceridemia and reduced HDL-C commonly occur, but in most cases insulin replacement in these patients correct these abnormalities. In T2DM, this phenotype is not usually fully corrected with glycemic control, suggesting that insulin resistance and not hyperglycemia per se are associated with this lipid abnormality.

Primary therapy should be directed towards lowering LDL-C levels. A statin should be chosen depending on the LDL-C reduction needed to achieve the target value (<70 mg/dl) and upon the judgment of the physician. Although usually not very effective for raising HDL-C levels, statins might be effective at reducing moderately elevated triglycerides, thus reducing the need for combination therapy. Addition of fibrates may be indicated when triglycerides are high and HDL-C is low.

This review will give an update regarding management of dyslipidemia of diabetic patients to achieve the best clinical outcome regarding reduction of CVS mortality.