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 ≥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.