Lipid-lowering diets: putting guidelines into practice

The incidence of cardiovascular disease is four to five times greater in people with diabetes than in people without diabetes. Lipid disorders, along with elevated blood pressure, cigarette smoking, and abdominal obesity, are major risk factors for people with diabetes. All adults with diabetes should be screened for blood lipid levels including triglycerides, cholesterol, and high-density lipoprotein (HDL) cholesterol. The low-density lipoprotein (LDL) cholesterol should be measured more routinely in people with diabetes than suggested in the National Cholesterol Education Project (NCEP) guidelines. No single diet is best for persons with diabetes. Sometimes a lower fat, higher carbohydrate diet is more acceptable, and other times a lower carbohydrate, higher monounsaturated fatty acid (MUFA) diet is preferred. The decision regarding the level of fat in the diet is based both on patient preference as well as serial measurements of metabolic control. Changing eating habits regarding lipids is a gradual process and can best be accomplished when introduced in a staged approach.