1. Dyslipidemia And Diabetes
Masoud Rahmanaian MD

2. Introduction
A 39 y-o man who diagnosed T2DM since 2 m ago and received OADs came in for consultation about his lipid profile. He is an obese man( BMI=32) with acanthosis nigricans and family history of CAD in her father when he had been 64 years old. He doesn’t smoke. His BP is 134/86 mmHg. He is on metformin 500mg tds and the last lab tests is noted:

3. Lab Tests
FPG= 134
2hPP= 156
A1C= 6.7%
Cr= 1.3
LFT→ NL
TG= 311
Tchol= 231
LDL= 134
HDL= 34

4. When Should We Screen Dyslipidemia In Diabetics?

5. Diabetic Dyslipidemia
↓HDL
↑TG
↑Small dense LDL
CAD is more prevalent among diabetics

6. Recommendation In adults, a screening lipid profile is
reasonable at the time of first diagnosis,
at the initial medical evaluation,
and/or at age 40 years and
periodically (e.g., every 1–2 years) thereafter
ADA 2015

7. What Is The Best Life Style Modification For Diabetes Dyslipidemia?

8. Effective Modalities Exercise Weight Loss Smoking Cessasion
↓ Saturated Fat
↓ Trans unsaturated Fat
↑ Fiber
Glycemic Control

9. When A Diabetic Patient Need Treatment For Dyslipidemia?

12. Indication of Statin
AHA 2013

13. AHA 2013

15. Monitoring Of Treatment?

16. Recommendation
Cholesterol laboratory testing may be helpful in monitoring adherence to therapy, but may not be needed once the patient is stable on therapy
ADA 2015

17. What About TG?

18. Recommendation For patients with fasting TG>500 mg/dL,
evaluate for secondary causes and consider
medical therapy to reduce risk of pancreatitis
ADA 2015

19. TG 150-499 Set LDL goal Set non-HDL cholesterol
Intensify tx with LDL lowering drugs
Add nicotinic acid or fibrate

20. Stain causes Diabetes?

21. TNT study 2013

22. Any Question?