Diabetes complicated by hyperlipidemia Drug guidance:
The characteristics of lipid metabolism disorders in patients with diabetes mellitus are elevated serum triglyceride levels and decreased high-density lipoprotein-cholesterol (HDL-C) levels, with normal or mildly elevated total cholesterol and low-density lipoprotein-cholesterol (LDL-C) levels.
Diabetes and hyperlipidemia both increase the risk of coronary heart disease, therefore, treatment should be strengthened for both conditions. For all patients with diabetes, LDL-C levels should be reduced to less than 3.4 mmol/L; for patients with a confirmed history of coronary heart disease, LDL-C levels should be reduced to less than 2.6 mmol/L.
Bile acid sequestrants such as cholestyramine (Statin) and colesevelam (Fibrate), although they can reduce serum LDL-C levels in patients with diabetes, tend to increase serum triglyceride levels, so these drugs are not suitable for use. Additionally, due to the fact that nicotinic acid can exacerbate glucose intolerance, it is not conducive to diabetes control and should not be selected. However, the nicotinic acid derivative acipimox (Lipostat) can reduce serum triglyceride and cholesterol levels, increase serum HDL-C levels, and improve glucose tolerance, making it suitable for the treatment of patients with diabetes and hyperlipidemia. When diabetes is complicated by elevated total cholesterol levels and normal or borderline increased serum triglyceride levels, statin lipid-lowering drugs such as pravastatin and simvastatin can be selected. The abnormal lipid metabolism in patients with diabetes increases the risk of recurrent coronary heart disease and other atherosclerotic events. Therefore, giving statin lipid-lowering drugs to reduce serum cholesterol, triglycerides, and very low density lipoprotein (VLDL) levels has the benefit of preventing and reducing the occurrence of various cardiovascular events, ultimately improving the prognosis of diabetes.
The method of treating diabetes with hyperlipidemia using statin drugs is to choose one of the three commonly used statin preparations on the basis of effectively controlling blood glucose and implementing dietary therapy. Among them, lovastatin or simvastatin are more appropriate. Lovastatin is taken at a dose of 20-40 mg once before dinner; simvastatin is taken at a dose of 20-30 mg before dinner. The course of treatment should generally last for at least 6 months, preferably 1 year. During the medication period, serum lipid levels should be checked every 12 weeks, and the dosage adjusted accordingly to maintain normal lipid levels.
