Diabetic dyslipidemia is a constellation of lipoprotein abnormalities characterized by increased triglycerides, decreased high-density lipoprotein-cholesterol levels, and an increase in small dense low-density lipoprotein (LDL). The condition is common in patients with type 2 diabetes, affecting over two-thirds of patients. Moreover, diabetes is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD), and elevated LDL-cholesterol is a major predictor of ASCVD events in patients with diabetes. Thus, there is considerable interest in adequate treatment of dyslipidemia in patients with type 2 diabetes. These presenters overviewed current knowledge of management of patients with diabetes and dyslipidemia.

• Type 2 diabetes has become much more common in adolescents in recent decades and is now present in a significant proportion of people.
• Youth with diabetes are also at higher risk of faster progression to insulin dependence, diabetic ketoacidosis, and autoimmune conditions.
• Lipids tend to be more elevated in those with type 2 diabetes vs. those with type 1 diabetes, and patients with diabetes and dyslipidemia are also at higher risk of diabetes-associated complications such as retinopathy and neuropathy.
• Screening for dyslipidemia should be performed at diagnosis in those with type 2 diabetes and after the age of 10 years in those with type 1 diabetes.
• Statins are the mainstay of treatment, aiming for a target LDL-cholesterol of <100 mg/dL, triglycerides <150 mg/dL, and HDL-cholesterol >35 mg/dL.
• Importantly, statins have no effect on growth and development of adolescents.
• The advantages of treating dyslipidemia include lowering CV risk and all-cause mortality.
• On the other hand, children would be subjected to lifelong therapy and there are little effects on arterial stiffness or endothelial function, together with the potential for drug-related side effects.
• Thus, clinicians should tailor management on an individualized basis, considering both the pros and cons of therapy.

• In older patients with diabetes and without CV disease, current guidelines suggest that persons who are already on statins should remain on them.
• Moderate-intense statin therapy should be given to individuals with clinical ASCVD.
• While therapy should be discussed with the patient before initiating a statin, it should also be pointed out that intensive statin therapy appears to be associated with a reduction in the risk of major CV events even in the elderly.
• However, there may be less benefit in those over the age of 75 years.
• Several features should be discussed before recommending a statin.
• These include the presence of comorbidities and overall prognosis, polypharmacy, and patient preferences.
• Furthermore, the perceived quality of life is an increasingly important aspect, as well as level of cognitive impairment and family opinions.
• Thus, the patient needs to be closely evaluated, and the risks of evidence-based therapy discussed.
• The physician should also explain the perceived risk vs. benefit ratio to the patients and/or family.

• Elevated triglycerides in the presence of LDL-cholesterol that is on target remains somewhat of a clinical dilemma.
• There are concerns over whether this condition should be treated, and if so how should this be approached.
• Data from NHANES have shown that hypertriglyceridemia is very common, and present in roughly 25% of individuals.
• In large meta-analyses, elevated triglycerides have been associated with increased risk for CV disease, with a similar impact on men and women, appearing to increase the risk for mortality by about 10%.
• Triglycerides are indeed an independent risk factor for ASCVD.
• With mild-moderately elevated triglycerides, the goal is to prevent clinical CV events, mainly using statin therapy.
• Physicians should look for both primary and secondary causes of elevates triglycerides, such as hypothyroidism, excess alcohol consumption, and weight gain.
• Lifestyle changes should be recommended when appropriate, and when needed fibrates, fish oil and niacin can be considered.
• Statins are not generally first-line therapy to lower triglycerides.
• Several newer agents are under development and clinical trials are underway to evaluate their efficacy and safety.
• Of note, icosapent ethyl recently received FDA approval for reduction of triglycerides in adults with severe hypertriglyceridemia.

• Patients with diabetes, severe chronic kidney disease (CKD), and dyslipidemia represent a difficult-to-treat population.
• These patients are at high risk for CV disease.
• In stage 3 CKD, statins have been shown to be as effective at reducing CV events as in individuals with normal renal function.
• However, in stage 5 CKD, the efficacy of statins at reducing the risk of CV outcomes is less clear.
• When administering lipid lowering agents to these patients, physicians should also carefully consider the lowest effective dose, and watchful dose adjustment is recommended.
• CKD is indeed a risk factor for coronary heart disease and should be treated accordingly.
• The target level of LDL-cholesterol in this case is ≤70 mg/dL.
• Statins should be the first line of therapy; patients on dialysis should be carefully evaluated.

• Patients with diabetes, severe chronic kidney disease (CKD), and dyslipidemia represent a difficult-to-treat population.
• These patients are at high risk for CV disease.
• In stage 3 CKD, statins have been shown to be as effective at reducing CV events as in individuals with normal renal function.
• However, in stage 5 CKD, the efficacy of statins at reducing the risk of CV outcomes is less clear.
• When administering lipid lowering agents to these patients, physicians should also carefully consider the lowest effective dose, and watchful dose adjustment is recommended.
• CKD is indeed a risk factor for coronary heart disease and should be treated accordingly.
• The target level of LDL-cholesterol in this case is ≤70 mg/dL.
• Statins should be the first line of therapy; patients on dialysis should be carefully evaluated.