Haffner Steven M
Department of Medicine, University of Texas Health Science Center at San Antonio, Texas 78284-7873, USA.
Diabetes Metab Res Rev. 2003 Jul-Aug;19(4):280-7. doi: 10.1002/dmrr.393.
The increasing prevalence of type 2 diabetes is a major problem for healthcare providers globally, since it is associated with serious microvascular and macrovascular complications. Although microvascular complications can be largely reduced with strict glycemic control, prevention of macrovascular disease involves a multifaceted approach that addresses all major risk factors, including dyslipidemia, hypertension, and insulin insensitivity. In particular, the treatment of diabetic dyslipidemia is a major challenge for diabetologists and cardiologists, as it is characterized by an array of lipid abnormalities. The management of diabetic dyslipidemia should initially include lifestyle approaches such as improved nutrition and weight reduction; however, the majority of patients require the addition of pharmacotherapy. Whilst insulin and/or oral hypoglycemic drugs are generally prescribed for the treatment of hyperglycemia, the addition of lipid-lowering drugs may be necessary for the control of diabetic dyslipidemia. The American Diabetes Association guidelines recommend lowering of low-density lipoprotein cholesterol (LDL-C) as a first priority. Hydroxy-methylglutaryl coenzyme A reductase inhibitors (statins) are recommended for first-line therapy in diabetic patients, since these agents are effective at reducing LDL-C levels. Whilst statins provide effective control of dyslipidemia in the majority of patients, more efficacious treatment regimens would provide greater benefit to more patients. Combination therapies may provide one solution to obtaining maximal lipid profile modifications, although the introduction of new, more efficacious agents for use as monotherapy may provide a more acceptable option, as drug combinations are often associated with poor tolerability and patient compliance.
2型糖尿病患病率的不断上升是全球医疗服务提供者面临的一个主要问题，因为它与严重的微血管和大血管并发症相关。虽然严格控制血糖可在很大程度上降低微血管并发症，但预防大血管疾病需要采取多方面的方法，解决所有主要危险因素，包括血脂异常、高血压和胰岛素不敏感。特别是，糖尿病血脂异常的治疗对糖尿病专家和心脏病专家来说是一项重大挑战，因为它具有一系列脂质异常特征。糖尿病血脂异常的管理最初应包括改善营养和减轻体重等生活方式措施；然而，大多数患者需要加用药物治疗。虽然通常使用胰岛素和/或口服降糖药治疗高血糖，但可能需要加用降脂药物来控制糖尿病血脂异常。美国糖尿病协会指南建议将降低低密度脂蛋白胆固醇（LDL-C）作为首要任务。羟甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）被推荐用于糖尿病患者的一线治疗，因为这些药物能有效降低LDL-C水平。虽然他汀类药物能有效控制大多数患者的血脂异常，但更有效的治疗方案将使更多患者受益更多。联合治疗可能是实现最大程度改善血脂谱的一种解决方案，不过引入新的、更有效的单一疗法药物可能是更可接受的选择，因为药物联合治疗往往耐受性差且患者依从性低。
