Management of dyslipidemia in NIDDM

Research output: Contribution to journalArticle

229 Citations (Scopus)

Abstract

Coronary heart disease is the leading cause of death among patients with non-insulin-dependent diabetes mellitus (NIDDM). NIDDM patients have a high frequency of dyslipidemia, which along with obesity, hypertension, and hyperglycemia may contribute significantly to accelerated coronary atherosclerosis. Because risk factors for coronary heart disease are additive and perhaps multiplicative, even mild degrees of dyslipidemia may enhance coronary heart disease risk. Therefore, therapeutic strategies for management of NIDDM should give equal emphasis to controlling hyperglycemia and dyslipidemia. The National Cholesterol Education Program recently issued guidelines for treatment of hyperlipidemia in adults including diabetic patients. Because of the unique features of diabetic dyslipidemia, however, we suggest that certain modifications in these guidelines be made to meet specific needs of diabetic patients. For example, therapeutic goals for serum cholesterol reduction should be lower in diabetic patients than in nondiabetic subjects. Particular emphasis should be given to weight reduction in NIDDM patients. In some diabetic patients, monounsaturated fatty acids may be a better replacement for saturated fatty acids than carbohydrates. The target for cholesterol lowering should include both very-low-density lipoprotein and low-density lipoprotein (LDL) (non-high-density lipoprotein) rather than LDL alone. To obtain a substantial reduction of cholesterol levels, drug therapy may be required in many patients. However, first-line drugs for nondiabetic patients (nicotinic acid and bile acid sequestrants) may be less desirable in NIDDM patients than hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitors and even fibric acids. In fact, HMG CoA reductase inhibitors may be the drugs of choice for NIDDM patients with elevated LDL cholesterol and borderline hypertriglyceridemia, whereas gemfibrozil appears preferable for NIDDM patients with severe hypertriglyceridemia.

Original languageEnglish (US)
Pages (from-to)153-169
Number of pages17
JournalDiabetes Care
Volume13
Issue number2
StatePublished - Feb 1990

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Dyslipidemias
Type 2 Diabetes Mellitus
Cholesterol
Coronary Disease
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hypertriglyceridemia
LDL Lipoproteins
Hyperglycemia
Oxidoreductases
Guidelines
Gemfibrozil
Fibric Acids
Monounsaturated Fatty Acids
VLDL Lipoproteins
Niacin
Hyperlipidemias
Bile Acids and Salts
Pharmaceutical Preparations
LDL Cholesterol
Weight Loss

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Management of dyslipidemia in NIDDM. / Garg, Abhimanyu; Grundy, Scott M.

In: Diabetes Care, Vol. 13, No. 2, 02.1990, p. 153-169.

Research output: Contribution to journalArticle

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