Abstract
Dyslipidemia in type 2 diabetics represents a complex change of lipoprotein metabolism that is highly proatherogenic. It originates on a genetic background in the context of insulin resistance and affects lipoprotein metabolism at multiple levels (e.g. hepatocyte, enterocyte, intravascular processing) mainly in the postprandial phase.
The treatment of diabetic (atherogenic) dyslipidemia is an effective option to lower the risk of both macro- and microvascular complications of diabetes. Lifestyle changes effectively impact on dyslipidemia in diabetics, however, it is impossible to reach treatment goals and achieve necessary risk reduction without lipid lowering medications.
Statins remain the corner stone of pharmacological therapy and they should be combined with ezetimibe (or a resin) in case of insufficient LDL-cholesterol lowering or with fenofibrate when triglyceride levels remain elevated. In near future these drugs will be available in new fixed-dose combination formulas.
Moreover, very soon PCSK9 inhibitors will get to clinical practice offering patients with diabetes additional LDL-cholesterol lowering by more than 50 %. Selective modulators of PPARα receptors are under development and these shall offer better efficacy and tolerability compared with fibrates.
Other future options for the management of diabetic dyslipidemia will be drugs utilizing the anti-sense technology interfering with translation of genes coding for metabolic pathways of lipoprotein species typically perturbed in type 2 diabetes (e.g. anti-sense oligonucleotides against mRNA of apolipoprotein CIII).