Correction of diabetic dyslipidaemia in diabetic patients is the most important factor in reducing cardiac risk. Diabetic dyslipidaemia is characterized by elevated
triglycerides, low total
high-density lipoprotein (HDL) and small dense
low-density lipoprotein (
LDL) particles. The most important therapeutic goal in diabetic dyslipidaemia is correction of the non-
HDL-cholesterol (HDL-C) level. Glycaemic control with particular attention to postprandial
glucose control plays a role not only in improving dyslipidaemia but also in lowering
cardiac events.
Pioglitazone is particularly effective for improving the manifestations of diabetic dyslipidaemia, in addition to its favorable effects on systemic
inflammation and hyperglycaemia. Use of
statins in addition to lifestyle change is recommended in most if not all type 2 diabetic patients and the goal should be to lower the
LDL to a level recommended for the patient with existing
cardiovascular disease (CVD) (non-HDL-C level <100 mg/dl). In addition,
therapies for normalization of HDL and
triglyceride levels should be deployed. Most patients with
type 2 diabetes (T2D) will require combining a
lipid-lowering
therapy with therapeutic lifestyle changes to achieve optimal
lipid levels. Combinations usually include two or more of the following: a
statin,
nicotinic acid, omega-3
fats and
bile acid sequestrants (BASs).
Fibrates may also be of use in diabetic patients with persistently elevated
triglycerides and depressed HDL-C levels, although their role in lowering adverse CV events is questionable.