[Diabetes mellitus and lipoproteins]

The leading cause of death of diabetic patients is coronary heart disease developing on the basis of accelerated arteriosclerosis. Lipoprotein disorders commonly accompanying diabetes mellitus (DM) promote this process and their joint presence represent cumulated risks for patients. The present review summarizes the various disorders accompanying the two types of DM. In case of insulin-treated, type I, well adjusted DM without signs of primary disturbances of lipid metabolism, quantitative lipid alterations cannot be found. In poorly treated DM with insufficient insulin levels the accumulation of triglyceride particles is due to diminished lipoprotein lipase activity. The main consequence is hyperchylomicronaemia but all three lipoprotein classes are affected. The most characteristic lipid abnormalities in non-insulin-dependent (type II) DM are hypertriglyceridaemia, increased VLDL cholesterol concentration and decreased HDL levels, which frequently remain unchanged even upon the proper treatment of glucose metabolism. The alterations are related to increased free fatty acid levels and decreased glucose uptake resulting from elevated insulin levels. In about one-fourth of cases, primary hyperlipaemia is also present. The treatment of primary and secondary lipid disorders accompanying DM by diet and drugs is of the most uttermost importance.