Plasma Lipids at diagnosis of Type 2 Diabetes UKPDS study group, Diabetes Care 1997; 20: 1683- 1687 1.4 (55) 1.1 (43) 1.1 (43) 1.0 (39) HDL-C mmol/l (mg/dl) 1.8 (159) 3.9 (151) 5.8 (224) 1574 Type 2 WOMEN 1.2 (103) 3.4 (132) 5.3 (205) 52 Control 1.1 (95) 3.5 (135) 5.6 (217) 143 Control 1.8 (159) 3.6 (139) 5.5 (213) 2139 Type 2 MEN TG mmol/l (mg/dl) LDL-C mmol/l (mg/dl) TC mmol/l (mg/dl) N UKPDS
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Plasma Lipids at diagnosis of Type 2 Diabetes UKPDS study group, Diabetes Care 1997; 20: 1683-1687 1.4 (55)1.1 (43) 1.0 (39)HDL-C mmol/l (mg/dl) 1.8 (159)
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Plasma Lipids at diagnosis of Type 2 Diabetes
UKPDS study group, Diabetes Care 1997; 20: 1683-1687
Risk Reduction 4 S trialEstimated CHD reduction after treating
100 CHD patients for 6 years
Expected fatal and non fatal Ml’s
Number of prevenedFatal and non fatal MI’s
patients with diabetes
patients without diabetes
49
29
24
9
Pyörälä K et al. Diabetes Care 20(4): 614 - 620, 1997
Management Of Lipids in Patients with Management Of Lipids in Patients with Diabetes Mellitus Type 2Diabetes Mellitus Type 2
Risk Factor Management General Rules
• Risk factor assessment• Setting goals for therapy
– Primary prevention– Secondary prevention
• Specific modalities of therapy based on impact and practicality– Lipid management– Asperin use– Blood pressure control– Smoking cessation– Glycemic control – Weight management
Suggested Risk Factor Target Levels
RISK FACTOR GOAL
Blood pressure 130/80 mm Hg
HbA1c <7.5%
BMI <25kg/m2
Waist circumferencemales <98 cmfemales <88 cm
Urinary albumin excretion <30 mg/day
Lipid Management Glycaemic Control
• Glucose lowering in untreated diabetics will
improve the lipidprofile
• Better glycaemic control, independent of mode of
therapy, further improves the lipidprofile
• Unfortunately target lipid levels are not achieved
with good glycaemic control in most patients
Lipid Targets for Patients with Type 2 Diabetes Mellitus
•Haffner SM. Management of dyslipidemia in adults withdiabetes [American Diabetes Association position state-ment].Diabetes Care. 1998;21:160-178.
•Garg A. Treatment of diabetic dyslipidemia. Am JCardiol. 1998;81(4A):47B-51B.