Lipids: impact on dietary prescription in diabetes

The rate of death from coronary artery disease is two to three times higher among individuals with diabetes than among their age- and sex-matched peers. In diabetes, many factors may affect blood lipid levels and complicate formulating an effective dietary prescription. Both Type I and Type II diabetes may have an independent effect on lipids. This article discusses metabolic derivations in carbohydrate and lipid metabolism that contribute to lipid abnormalities. The National Cholesterol Education Program Guidelines, which include dietary recommendations for lowering blood lipid levels by modifying fat intake, are discussed in regard to their effect on blood lipids in diabetes and their effect on other variables, such as blood glucose control. Other treatment approaches common in diabetes and lipid management include low-calorie diets and weight reduction, a change in the fatty acid composition of the diet, and high-carbohydrate diets. An evaluation of the etiologies of lipid abnormalities and interventions directed toward lipid levels and other indexes of diabetes management may lead to improved lipid levels, improved blood glucose control, and avoidance of unnecessary, ineffective, or deleterious dietary prescriptions for individuals with diabetes.