Managing Hyperlipidemia in Patients with Diabetes

It is estimated that 25% of the US population have 3 or more clustered risk factors for the development of cardiovascular disease (CVD), including obesity, insulin resistance, sedentary lifestyle, smoking, excessive use of alcohol, and hyperlipidemia. These risk factors are even more prevalent in persons with co-existing hypertension and type 2 diabetes mellitus (T2DM). A simple paradigm suggests that inflammatory conditions increase insulin resistance contributing to obesity and leading to T2DM, hypertension, prothrombic derangements, and dyslipidemia. Pharmacologic and non-pharmacologic interventions should be based on a working knowledge of the complex interrelationship among these various cardiovascular risk factors. Reducing risk factors for CVD in persons with T2DM is a formidable task for clinicians and patients, requiring the administration of multiple medications, close monitoring and good communication. Lifestyle modification has also been shown to be beneficial for patients at high risk of CVD and events. These include moderate weight loss, smoking abstention, restriction of daily sodium intake to less than 3 gm, daily consumption of at least 3.5 gm of potassium (preferably from fresh fruits and vegetables), limitation of alcohol intake, and 30 minutes of moderately intense daily exercise.

In this conversation, three endocrinologists, Dr. Paul Jellinger, Dr. Joseph Torre and Dr. Vijay Nambi, join Dr. Carlos Hamilton, Jr. to discuss current issues primarily surrounding the non-pharmacological management and control of hyperlipidemia in diabetic patients.

Related References/Reading:

  1. AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract. 2007;13 Suppl 1:1-68.
  2. Jones PH. Clinical significance of recent lipid trials on reducing risk in patients with type 2 diabetes mellitus. Am J Cardiol. 2007;99(4A):133B-140B
  3. Lee M, Aronne LJ. Weight management for type 2 diabetes mellitus: global cardiovascular risk reduction. Am J Cardiol. 2007;99(4A):68B-79B.