Miss Directed. Weight Loss

Guidelines for optimal control of plasma lipid or lipoproteins in c betes mellitus are based on the recognition that both type 1 and type of  diabetic patients have disordered lipid metabolism. In type 1 diabetes, elevations of triglycerides, low HDL-cholesterol and elevation of LDL cholesterol are particularly dependent on poor glycemic control and tend to return to normal with intensive insulin therapy. An atherogenic lipoprotein profile usually accompanies diabetic nephropathy. People with type 1 diabetes have a shortened lifespan that is due primarily either to renal insufficiency or to cardiovascular events—and, often a combination of both. Thus, strict guidelines for lipoprotein control apply to people with type 1 diabetes. In type 2 diabetes, dyslipidemia is often characterized by low plasma HDL-C, high plasma triglyceride levels, and a population of small, dense LDL particles, which are particularly atherogenic. Cardiovascular disease is the major cause of death in type 2 diabetes, and dyslipidemia is probably a major contributor.

In type 2 diabetes (in contrast to type 1 diabetes), abundant evidence from prospective randomized trials shows that intensive management of lipids and lipoproteins is indicated to reduce the risk for cardiovascular events. This subject is covered in detail in future chapters. There is now substantial agreement between the American Diabetes Association and the National Cholesterol Education Program15 regarding guidelines for therapy of lipids and lipoproteins in adults with diabetes mellitus.

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