Diabetes and dyslipidaemia

The risk of developing cardiovascular disease (CVD) is higher and the prognosis poorer for diabetic than for non-diabetic individuals. Diabetic dyslipidaemia is characterized by hypertriglyceridaemia, low levels of high-density lipoprotein cholesterol (HDL-C) and the presence of small, dense low-density lipoprotein (LDL) particles. Increased physical activity and weight loss are the first steps in managing diabetic dyslipidaemia. A secondary goal is to achieve non-HDL-C targets with cholesterol-lowering therapy. Improved glycaemic control, the first priority in managing hypertriglyceridaemia, can also aid in lowering levels of LDL-C. Lipid-lowering therapy should be initiated if lifestyle changes and glycaemic control fail to reduce LDL-C levels to <100 mg/dl (5.5 mmol/l), regardless of the status of CVD, coronary heart disease or peripheral vascular disease, and to reduce triglyceride levels of > or =150 mg/dl (8.3 mmol/l). Many diabetic patients may need oral hypoglycaemic agents or insulin to achieve adequate glycaemic control. Intensive insulin therapy can provide tight glycaemic control and reduce elevated triglyceride levels.