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Treatment of diabetic dyslipoproteinemia.
Exp Clin Endocrinol Diabetes. 2003 Aug; 111(5):239-45.EC

Abstract

Diabetes mellitus, specifically type 2, is often associated with disorders in lipid metabolism. Elevated levels of plasma free fatty acids play a pivotal role by contributing significantly to insulin resistance. In addition free fatty acids promote diabetic dyslipidemia through increasing VLDL synthesis in the liver, and by virtue of cholesterylester transfer protein, modifying LDL to increase small-dense LDL subfractions and to decrease HDL cholesterol. This atherogenic lipoprotein profile (elevated triglycerides, increased small-dense low-density lipoproteins, and decreased high-density lipoproteins), contributes to the development of atherosclerosis and increases the risk of experiencing cardiovascular events, the most common cause of death in type 2 diabetes. To decrease the risk of cardiovascular disease events in diabetics, dyslipidemia needs to be treated, as evidenced from epidemiology, from intervention trials, and from subgroup analyses of large intervention trials initiated to evaluate effects of lipid lowering treatment that also included patients with type 2 diabetes. Most measures used to counteract hyperglycemia, are also prone to ameliorate dyslipidemia: dietary intervention (medical nutrition) including omega-3 fatty acids as part of lifestyle changes that also comprise cessation of smoking, increases in physical activity and reduction in body weight. In addition insulin, biguanides, acarbose and glitazones applied for glycemic control also improve diabetic dyslipidemia. Additional pharmacological treatment of dyslipidemia if persisting after glycemic control relies on different drug classes. Fibrates effectively reduce free fatty acids, fasting and postprandial lipemia, shift the distribution of LDL particles towards less dense subfractions and increase HDL cholesterol, thus particularly addressing key components of diabetic dyslipidemia. For LDL cholesterol lowering statins are mainly used that decrease LDL cholesterol levels by competitive inhibition of the HMG-CoA reductase. As type 2 diabetes is found to be associated with a two- to fourfold increase in coronary heart disease risk and as the degree of glycemia is more related to microvascular complications, correcting dyslipidemia appears to be a major task in order to reduce macrovascular events in patients with type 2 diabetes.

Authors+Show Affiliations

Steinmetz A
Department of Internal Medicine, St. Nikolaus-Stiftshospital GmbH Andernach, Teaching Hospital University of Bonn, Andernach, Germany. armin.steinmetz@stiftshospital-andernach.de

MeSH

Alcohol DrinkingAppetite DepressantsBlood GlucoseDiabetes ComplicationsDiabetes MellitusHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHyperlipoproteinemiasHypolipidemic AgentsLife StyleNutritional Physiological PhenomenaSmoking

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12951627

Citation

Steinmetz, A. "Treatment of Diabetic Dyslipoproteinemia." Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association, vol. 111, no. 5, 2003, pp. 239-45.
Steinmetz A. Treatment of diabetic dyslipoproteinemia. Exp Clin Endocrinol Diabetes. 2003;111(5):239-45.
Steinmetz, A. (2003). Treatment of diabetic dyslipoproteinemia. Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association, 111(5), 239-45.
Steinmetz A. Treatment of Diabetic Dyslipoproteinemia. Exp Clin Endocrinol Diabetes. 2003;111(5):239-45. PubMed PMID: 12951627.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of diabetic dyslipoproteinemia. A1 - Steinmetz,A, PY - 2003/9/3/pubmed PY - 2004/4/22/medline PY - 2003/9/3/entrez SP - 239 EP - 45 JF - Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association JO - Exp Clin Endocrinol Diabetes VL - 111 IS - 5 N2 - Diabetes mellitus, specifically type 2, is often associated with disorders in lipid metabolism. Elevated levels of plasma free fatty acids play a pivotal role by contributing significantly to insulin resistance. In addition free fatty acids promote diabetic dyslipidemia through increasing VLDL synthesis in the liver, and by virtue of cholesterylester transfer protein, modifying LDL to increase small-dense LDL subfractions and to decrease HDL cholesterol. This atherogenic lipoprotein profile (elevated triglycerides, increased small-dense low-density lipoproteins, and decreased high-density lipoproteins), contributes to the development of atherosclerosis and increases the risk of experiencing cardiovascular events, the most common cause of death in type 2 diabetes. To decrease the risk of cardiovascular disease events in diabetics, dyslipidemia needs to be treated, as evidenced from epidemiology, from intervention trials, and from subgroup analyses of large intervention trials initiated to evaluate effects of lipid lowering treatment that also included patients with type 2 diabetes. Most measures used to counteract hyperglycemia, are also prone to ameliorate dyslipidemia: dietary intervention (medical nutrition) including omega-3 fatty acids as part of lifestyle changes that also comprise cessation of smoking, increases in physical activity and reduction in body weight. In addition insulin, biguanides, acarbose and glitazones applied for glycemic control also improve diabetic dyslipidemia. Additional pharmacological treatment of dyslipidemia if persisting after glycemic control relies on different drug classes. Fibrates effectively reduce free fatty acids, fasting and postprandial lipemia, shift the distribution of LDL particles towards less dense subfractions and increase HDL cholesterol, thus particularly addressing key components of diabetic dyslipidemia. For LDL cholesterol lowering statins are mainly used that decrease LDL cholesterol levels by competitive inhibition of the HMG-CoA reductase. As type 2 diabetes is found to be associated with a two- to fourfold increase in coronary heart disease risk and as the degree of glycemia is more related to microvascular complications, correcting dyslipidemia appears to be a major task in order to reduce macrovascular events in patients with type 2 diabetes. SN - 0947-7349 UR - https://www.unboundmedicine.com/medline/citation/12951627/Treatment_of_diabetic_dyslipoproteinemia_ DB - PRIME DP - Unbound Medicine ER -