Diabetic dyslipidemia and its therapy

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Patients with diabetes, including those with IDDM, NIDDM, and other types, are at an increased risk for coronary heart disease (CHD). Factors that may enhance CHD risk include hyperglycemia, hypertension, and dyslipidemia. Diabetic dyslipidemia is characterized by multiple lipoprotein defects, including moderately high serum levels of cholesterol and triglycerides, small LDL particles, and low levels of HDL cholesterol. The results of recent clinical trials reveal beneficial effects of cholesterol-lowering therapy in diabetic and nondiabetic patients, thus supporting increased emphasis on treatment of diabetic dyslipidemia. This need for intensive treatment of diabetic dyslipidemia was advocated by the recent report of the National Cholesterol Education Program's Adult Treatment Panel II. A three-step approach to treatment of diabetic patients with dyslipidemia can be recommended. First, life habits, including intakes of cholesterol and cholesterol-raising fats, total energy, and physical activity, should be modified appropriately. Second, good glycemic control, with drugs if necessary, should be achieved. Third, atherogenic lipoproteins should be effectively reduced, with drugs if necessary. Clinical trials indicate that priority should be given to reducing atherogenic lipoproteins (LDL and VLDL). An appropriate target of therapy is VLDL + LDL (non-HDL) cholesterol levels. Cholesterol-lowering drugs (hydroxymethylglutaryl [HMG] CoA reductase inhibitors [statins] and bile acid sequestrants) are first-line drug therapy for diabetic dyslipidemia. Patients with severe hypertriglyceridemia may require fibric acids to prevent development of acute pancreatitis. Although nicotinic acid seems to be an attractive drug for diabetic dyslipidemia, it worsens hyperglycemia; therefore, it must be avoided in most cases. The value of estrogen-replacement therapy in postmenopausal women with diabetes has not been determined.

Original languageEnglish (US)
Pages (from-to)425-433
Number of pages9
JournalDiabetes Reviews
Volume5
Issue number4
StatePublished - 1997

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Dyslipidemias
Cholesterol
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hyperglycemia
Therapeutics
Lipoproteins
Coronary Disease
Clinical Trials
Pharmaceutical Preparations
Fibric Acids
Estrogen Replacement Therapy
VLDL Lipoproteins
Hypertriglyceridemia
Niacin
Drug and Narcotic Control
Hypercholesterolemia
Bile Acids and Salts
Type 1 Diabetes Mellitus
LDL Lipoproteins
Pancreatitis

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

Diabetic dyslipidemia and its therapy. / Garg, A.; Grundy, S. M.

In: Diabetes Reviews, Vol. 5, No. 4, 1997, p. 425-433.

Research output: Contribution to journalArticle

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