GENETIC PREDISPOSITION TO HYPERLIPIDEMIA IN DIABETES - THE END OF THEBEGINNING

Diabetes mellitus leads to disturbances in lipoprotein homeostasis par ticularly when there is poor glycaemic control. The resulting abnormal ities in concentration and composition of the circulating lipoproteins are modified by inherited variation in the genes coding for apolipopr oteins, for the lipoprotein-processing enzymes, and possibly for lipop rotein receptors. Thus, poorly controlled diabetes provides an opportu nity to observe the phenotypic effects of recessive mutant alleles tha t would otherwise be silent. This phenomenon should be considered when one attempts to understand the pathogenesis of variant phenotypes, on es differing from those typical of diabetes mellitus alone. Our unders tanding of how genetic variation modulates the expression of hyperlipi daemia in diabetes is still rudimentary-it now seems probable that man y other genetic conditions affecting lipoprotein metabolism in diabete s will eventually be brought to light.