The approach to dyslipidemia in patients with type 2 diabetes

Abstract

Being the Type 2 Diabetes Mellitus (T2DM) is a problem of Primary Health Care (PHC), is a vocation and mission of Family Physician (MF) the management of people and families with this problem. Thus, the MF has a responsibility to meet the objectives to be achieved and the therapeutic measures more appropriate to promote metabolic control and prevent the complications inherent in this type patients, particularly in relation to dyslipidemia. The main cause of death in diabetic patients is cardiovascular disease (CV). Dyslipidemia present in person with DM2 is one of the most important risk factors for morbidity and mortality in cardiovascular disease (CVD) 1-6. Elevated triglycerides (TG), the reduction of high density lipoproteins (HDL-C) and the presence of small, dense particles of low density lipoproteins (LDL-C) characteristics Profile of diabetic dyslipidemia (DD) are crucial in the process of accelerated atherogenesis that occurs in this dismetabolia. Clinical trials conducted randomized controlled type 2 diabetic patients show that treatment of dyslipidemia reduces the incidence of fatal and nonfatal coronary and other manifestations of DCV2, 15. The DD approach supported by the evidence needs to include: 1) categorize cardiovascular risk, 2) know the lipid profile of all diabetic patients at least annually; 3) establish non-pharmacological therapy with lifestyle modification focusing on diet, exercise and weight loss (if necessary); 4) to diabetic people diagnosed without CVD, point to the primary target LDL-C levels less than 100 mg / dl, if aged 40 years prescribed statin treatment to lower values LDL-C by 30 to 40% from baseline, if younger than 40 years, but the risk is high due to other cardiovascular risk factors and do not reach target values ??with non-pharmacological therapy modification of lifestyles, add pharmacological treatment; 5) for people diagnosed with diabetes and CVD, statin therapy should be prescribed to all, with the aim of reducing the values LDL-C by 30 to 40% compared to baseline; 6) reduce triglyceride to below 150 mg / dl and increase HDL-c to greater than 40 mg for men and above 50 mg / dl in women, 7) using fibrates to treat hypertriglyceridemia, HDL hypocholesterolemia and diabetic diagnosed with CVD and LDL-c within or very close to normal and 8) consider combination therapy using statins and other lipid-lowering agents (fibrates, ezetimibe, niacin and fatty acids W3) 3 to achieve the target values