The atherogenic lipid profile is associated with type 2 diabetes and some of its treatment modalities

Since diabetes is strongly linked to cardiovascular disease, we tested whether: 1) diabetic patients have a high prevalence of the atherogenic lipid profile and 2) the drugs used to treat hyperglycemia are related to the atherogenic lipid profile.

Seventy-two diabetic patients were retrospectively studied for lipids using the Lipid Research Clinic methods and LDL and HDL gel electrophoreses.

Despite normal mean levels of total LDL- and HDL-cholesterol (HDL-c), diabetic patients had abnormal mean levels and an unusually high prevalence of lipid abnormalities not apparent on routine lipid blood tests. Thus, mean LDL peak particle diameter (PPD) was 258 +/- 11A and values < 263A occurred in 57% of diabetic patients; HDL2 < 40% in 61% and Lp(a) > 25 mg/dl occurred in 36% of patients, despite good glycemic control. Mean HbA1c [Diabetes Control and Complications Trial (DCCT) formatted] was 6.5 +/- 1.4%. In contrast to patients using sulfonylureas or metformin, diabetic patients using insulin had significantly larger mean LDL PPD (261 vs 254A, p < 0.006), lower triglycerides (115 vs 215 mg/dl,p < 0.0001), higher HDL-c (53 vs 40 mg/dl,p < 0.0001) and higher HDL2 levels (43 vs 29%, p < 0.0001).

In this diabetic group, traditional guidelines fail to identify patients with high dyslipidemic prevalence rates (84%). Further, certain oral hypoglycemic treatments are associated with less favorable atherogenic lipid profiles when compared to insulin treatment.