ABSTRACT
Lipid disorders assume a position of utmost importance in patients with diabetes because of the high risk of macrovascular disease in this condition. Patients with well controlled type 1 diabetes mellitus (DM) have lipoprotein concentrations similar to the background non-diabetic population. With poor control, increased concentrations of triglyceride-rich lipoproteins are seen giving rise to hypertriglyceridemia. The most common lipoprotein abnormality in type 2 diabetes is an elevation in triglycerides and very-low-density lipoprotein (VLDL) caused by an overproduction of VLDL triglyceride. Lipoprotein lipase activity is probably decreased in type 2 diabetes, possibly as a manifestation of insulin resistance, and this may be a direct cause of elevated VLDL levels. No consistent changes in low-density lipoprotein (LDL) cholesterol are seen in type 2 diabetes, but a number of potentially atherogenic changes in LDL composition have been observed particularly a predominance of small dense LDL particles. The finding of decreased high-density lipoprotein (HDL) concentrations is very prevalent in type 2 diabetes adding to the atherogenic lipid profile of this disorder. No consistent change in lipoprotein a (Lp(a)) concentrations has been found in type 2 diabetes.
