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Dyslipidemia in type 2 diabetes mellitus

Abstract

Dyslipidemia is one of the major risk factors for cardiovascular disease in diabetes mellitus. The characteristic features of diabetic dyslipidemia are a high plasma triglyceride concentration, low HDL cholesterol concentration and increased concentration of small dense LDL-cholesterol particles. The lipid changes associated with diabetes mellitus are attributed to increased free fatty acid flux secondary to insulin resistance. The availability of multiple lipid-lowering drugs and supplements provides new opportunities for patients to achieve target lipid levels. However, the variety of therapeutic options poses a challenge in the prioritization of drug therapy. The prevalence of hypercholesterolemia is not increased in patients with diabetes mellitus, but mortality from coronary heart disease increases exponentially as a function of serum cholesterol levels, and lowering of cholesterol with statins reduces diabetic patients' relative cardiovascular risk. Although drug therapy for dyslipidemia must be individualized, most people with diabetes mellitus are candidates for statin therapy, and often need treatment with multiple agents to achieve therapeutic goals.

Key Points

  • Dyslipidemia contributes to the increased risk of cardiovascular disease in diabetes mellitus

  • The characteristic features of diabetic dyslipidemia are high plasma triglyceride concentration, low HDL cholesterol concentration and increased concentration of small dense LDL cholesterol

  • The most likely cause of diabetic dyslipidemia is the increased free fatty-acid flux, secondary to insulin resistance

  • Although drug therapy for dyslipidemias must be individualized, most people with diabetes mellitus are candidates for statin therapy and often need to be treated with multiple agents to achieve therapeutic goals

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Figure 1: The role of insulin resistance in diabetic dyslipidemia.
Figure 2: A suggested algorithm for drug therapy of dyslipidemia in patients with diabetes mellitus.

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Mooradian, A. Dyslipidemia in type 2 diabetes mellitus. Nat Rev Endocrinol 5, 150–159 (2009). https://doi.org/10.1038/ncpendmet1066

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