Treatment of Dyslipidemia in Patients with Type 1 Diabetes Mellitus: A Review of Current Evidence and Knowledge Gaps.

Type 1 diabetes (T1D) is a chronic condition with an increasing prevalence worldwide and a significant improvement in life expectancy in the last decades. T1D confers an increased risk of cardiovascular events, driven by elevated LDL cholesterol (LDL-C) and qualitative lipoprotein abnormalities, such as dysfunctional HDL and smaller, denser LDL-C. Lipid-lowering outcome trials have overwhelmingly focused on type 2 diabetes or the general population, resulting in very limited T1D-specific evidence. Recommendations from major medical associations (ADA, ESC/EAS, ACC/AHA, ISPAD) create additional ambiguity regarding the treatment of dyslipidemia in T1D. This review synthesizes the available evidence on dyslipidemia management in T1D, including published observational cohorts, randomized controlled trials, and international guideline recommendations from January 2000 to June 2025. LDL-C remains the primary modifiable risk factor. Each 1 mmol/L increase is associated with 35-50% greater cardiovascular (CV) risk in T1D cohorts. Statin therapy reduces CV risk by up to 25% in patients with diabetes; however, evidence remains limited in patients with T1D. Ezetimibe provides an additional 18% LDL-C lowering and a 14% event reduction in mixed-diabetes trials, while PCSK9 inhibitors offer a potent 40-60% LDL-C reduction and an 18% MACE reduction. The uptake of statins in eligible adults with T1D remains below 50%. Statins remain the cornerstone of dyslipidemia management in T1D, with emerging evidence supporting ezetimibe and PCSK9 inhibitors. The heterogeneity across international guidelines and the scarcity of T1D-specific outcome data underscore the need for targeted research and evidence-based strategies.