Diabetic dyslipidaemia

Dyslipidaemia is an important component of the metabolic syndrome observed in patients with type 2 diabetes, and is characterized by moderate hypertriglyceridaemia and low levels of high-density lipoprotein (HDL) cholesterol concentrations. Dyslipidaemia contributes to increased vascular risk and is therefore a good target for therapeutic intervention in the form of glycaemic control, lifestyle measures and hypolipidaemic drugs. It is proposed that lipid abnormalities in type 2 diabetes are secondary consequences of insulin resistance. Any approach that lowers insulin resistance would be anticipated to have a beneficial effect on dyslipidaemia, but in many cases patients with type 2 diabetes fail to achieve normal lipidaemia through diet, exercise and glycaemic control. Subgroup analyses of major clinical trials suggests that lipid-lowering therapy reduces CHD risk in patients with diabetes, but trials performed specifically in populations of patients with diabetes are ongoing. Until then, patients with type 2 diabetes who have established CHD or high individual risk already warrant aggressive lipid-lowering pharmacotherapy. In the author's view, when ongoing studies are complete it is likely that most patients with type 2 diabetes will be prescribed lipid-lowering drugs.