Written By: IJCP Editorial Team

Published On: 25 Mar, 2025 12:57 PM | Updated On: 25 Mar, 2025 12:59 PM

Management of Dyslipidemia in Diabetes

Diabetes mellitus (DM) is a metabolic disorder that increases the risk of cardiovascular diseases (CVD), a leading cause of illness and death in both type 1 (T1DM) and type 2 diabetes (T2DM) patients. While good glycemic control in T1DM can reduce cardiovascular events, it does not significantly impact CVD risk in T2DM. Many T2DM patients also experience dyslipidemia, characterized by low high-density lipoprotein (HDL) cholesterol, high triglycerides, and minor changes in low-density lipoprotein (LDL) cholesterol. This dyslipidemia results from excessive production of very low-density lipoproteins (VLDL) by the liver and is linked to increased risk of atherosclerotic cardiovascular disease and coronary heart disease.

Treatment Approaches for Lipid Lowering in Diabetes

Lifestyle Modifications:

The initial approach for managing dyslipidaemia in diabetes typically involves lifestyle changes, including weight loss, dietary adjustments, and regular aerobic exercise, which can improve lipid profiles and reduce cardiovascular risks. 

Pharmacological Treatments:

Medications for diabetic dyslipidaemia include glucose and lipid-lowering agents, with some diabetes medications also affecting lipid levels.

• Statins

Statins are a significant advancement in cardiovascular care, effectively lowering cholesterol and reducing CHD risk. A meta-analysis showed that statin therapy significantly decreases all-cause mortality and major vascular events in T2DM patients. However, they may slightly increase diabetes risk in those with prediabetes, though the effect is minimal in existing diabetic patients. Fibrates

• Fibrates

Fibrates are another class of medications that lower triglycerides and modestly increase HDL cholesterol, potentially reducing cardiovascular events in diabetic patients. The FIELD trial demonstrated that fenofibrate treatment improved lipid levels and led to an 11% reduction in coronary events and a 24% decrease in non-fatal myocardial infarctions among T2DM patients. 

• Bempedoic Acid

Bempedoic acid, a newer drug, inhibits cholesterol biosynthesis and has shown significant cardiovascular risk reductions without increasing diabetes risk. It also slightly lowers HbA1c levels. 

• Other Lipid-Lowering Options

Other medications such as ezetimibe and colesevelam serve as second-line options for LDL cholesterol reduction and can also help lower HbA1c. Emerging therapies like PCSK9 inhibitors have shown promising lipid-lowering effects in patients with T2DM.

In conclusion, stringent lipid control is crucial for reducing cardiovascular event risk in diabetes patients. Effective management involves lifestyle changes and intensive drug therapy to address dyslipidaemia. Modern treatments ensure that individuals with diabetes and high lipid levels are properly managed to minimize adverse cardiovascular outcomes associated with type 2 diabetes mellitus.

Source: Kalra S, Raizada N. Dyslipidemia in diabetes. Indian Heart J. 2024 Mar;76 Suppl 1(Suppl 1):S80-S82. doi: 10.1016/j.ihj.2023.11.002. Epub 2023 Nov 11. PMID: 37956957; PMCID: PMC11019325.