Jayakumari Chellamma, Jabbar Puthiyaveettil Khadar, Soumya Sarayu, Jayakumar R V, Das Darvin Vamadevan, Girivishnu Gopi, Gopi Anjana, Gomez Ramesh, Sreenath Ravindranath, Nair Abilash
Department of Endocrinology and Metabolism, Government Medical College, Thiruvananthapuram, India.
Indian Institute of Diabetes, Thiruvananthapuram, India.
Diabetes Spectr. 2020 Nov;33(4):299-306. doi: 10.2337/ds19-0046.
Reduction of atherosclerotic cardiovascular disease (ASCVD) risk in patients with diabetes requires proper management of lipid parameters. This study aimed to find the pattern of dyslipidemia and scope of ASCVD risk reduction in patients with diabetes by lipid management.
Clinical, biochemical, and medication profiles of all patients with diabetes attending a tertiary diabetes care hospital over a 2-year period were collected. The prevalence of various lipid abnormalities was determined after excluding patients with thyroid dysfunction and those on lipid-lowering medications. Patients were stratified according to LDL cholesterol, HDL cholesterol, and triglyceride levels, and other clinical parameters were compared among the groups. The adequacy of statin treatment was assessed based on American Diabetes Association guidelines.
Nine hundred and seventy-one patients were included. The prevalence of hyperlipidemia was 40.0%, of whom 14.6% were newly diagnosed. The most common lipid abnormality was elevated LDL cholesterol. Higher A1C and fasting blood glucose values were found to be associated with higher LDL cholesterol levels. Twenty-seven percent of patients with indications for treatment with statins were receiving them. Of those being treated with statins, 42.6% had an LDL cholesterol level ≥100 mg/dL.
In South Indian patients with type 2 diabetes and fair glycemic control, high LDL cholesterol is the predominant lipid abnormality. There remains a huge potential for ASCVD risk reduction in this population if the knowledge practice gap is addressed.
降低糖尿病患者的动脉粥样硬化性心血管疾病（ASCVD）风险需要对血脂参数进行适当管理。本研究旨在通过血脂管理找出糖尿病患者血脂异常的模式以及降低ASCVD风险的范围。
收集一家三级糖尿病专科医院2年内所有糖尿病患者的临床、生化和用药资料。排除甲状腺功能障碍患者和正在服用降脂药物的患者后，确定各种血脂异常的患病率。根据低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和甘油三酯水平对患者进行分层，并比较各组的其他临床参数。根据美国糖尿病协会指南评估他汀类药物治疗的充分性。
纳入971例患者。高脂血症患病率为40.0%，其中14.6%为新诊断患者。最常见的血脂异常是LDL-C升高。发现较高的糖化血红蛋白（A1C）和空腹血糖值与较高的LDL-C水平相关。有他汀类药物治疗指征的患者中，27%正在接受治疗。在接受他汀类药物治疗的患者中，42.6%的LDL-C水平≥100mg/dL。
在血糖控制良好的南印度2型糖尿病患者中，高LDL-C是主要的血脂异常。如果知识与实践之间的差距得到解决，该人群降低ASCVD风险仍有巨大潜力。
