Dyslipidaemia in diabetes

E78.0-6/E78.8-9

DESCRIPTION

Dyslipidaemia in type 2 diabetes is usually characterised by increased fasting plasma triglycerides (> 1.7 mmol/L), decreased HDL cholesterol (< 1.0 mmol/L in men and < 1.3mmol/L in women) and to a lesser extent, increased LDL cholesterol. In those with type 1 diabetes, triglycerides, and to a lesser extent cholesterol concentration, are usually increased.

MONITORING

See Type 2 diabetes mellitus, in adults.

MEDICINE TREATMENT

Dyslipidaemia may successfully be treated through lifestyle modifications alone.

  • HMGCoA reductase inhibitor (statin) therapy should be added to lifestyle modifications, regardless of baseline lipid concentrations, for all type 2 diabetic patients, who:
    • are > 40 years of age;
    • have had diabetes for > 10 years;
    • have existing cardiovascular disease (for example angina pectoris, previous myocardial infarction, peripheral vascular disease or stroke);
    • have chronic kidney disease (eGFR< 60 mL/minute);
    • type 1 diabetes with microalbuminuria
  • e.g., Simvastatin, oral, 10 mg at night.

LoEIII[12]

In patients < 40 years of age, risk assess as for dyslipidaemia; patients on protease inhibitors or amlodipine, See Prevention of ischaemic heart disease and atherosclerosis.

REFERRAL

  • Random cholesterol > 7.5 mmol/L.
  • Fasting (14 hours) triglycerides > 10 mmol/L.