Diabetic dyslipidaemia - Current treatment recommendations

Insulin deficiency and hyperglycaemia in type 1 (insulin-dependent) diabete s mellitus produce lipid abnormalities, which can be corrected by appropria te insulin therapy. Diabetic nephropathy, which is the main risk factor for coronary heart disease (CHD) in type 1 diabetes, causes pro-atheroscleroti c changes in lipid metabolism. Detection and treatment of elevated choleste rol levels is likely to be of benefit in these patients. Type 2 (noninsulin-dependent) diabetes mellitus is associated with abnormal lipid metabolism, even when glycaemic control is good and nephropathy abse nt. Elevated triglyceride levels, reduced high density lipoprotein (HDL) ch olesterol and a preponderance of small, dense low density lipoprotein (LDL) particles are the key abnormalities that constitute diabetic dyslipidaemia . The prevalence of hypercholesterolaemia is the same as for the nondiabeti c population, but the relative risk of CHD is greatly increased at every le vel of cholesterol. Based on effectiveness, tolerability and clinical trial results, treatment with HMG-CoA reductase inhibitors to lower LDL choleste rol is recommended as primary therapy. These agents are also moderately eff ective at reducing triglyceride and increasing HDL cholesterol levels. If h ypertriglyceridaemia predominates, treatment with fibric acid derivatives i s appropriate, although there is currently only limited clinical trial evid ence that the risk of CHD will be reduced. In type I diabetes, but particularly in type 2 diabetes, lipid disorders ar e likely to contribute significantly to the increased risk of macrovascular complications, especially CHD. Management of the disordered lipid metaboli sm should be given a high priority in the clinical care of all patients wit h diabetes.