Hyperlipidémie des diabétiques

Lipid abnormalities are frequent and pronounced in patients with diabetes mellitus. They are partly responsible for the increased cardiovascular risk observed in this population, particularly in type 2 diabetic subjects. Type 2 diabetic patients present both quantitative and qualitative abnormalities of lipoproteins, when type 1 diabetic patients in good (or fairly good) glycemic control have only qualitative abnormalities. Quantitative abnormalities of lipoproteins are elevated triglycerides and decreased HDL-cholesterol level. Main qualitative abnormalities are large triglyceride-rich VLDL (VLDL₁), small dense triglyceride-rich LDL, increased oxidation of LDL, triglyceride-rich HDL and glycation of apolipoproteins. Both quantitative and qualitative abnormalities are atherogenic. In type 2 diabetes, insulin resistance and insulin "relative" failure play a crucial role in the physiopathology of lipid disorders. Treatment of diabetic hyperlipidemia, which is important to reduce cardiovascular risk, is based on diet, physical activity, glycemic control and hypolipidemic drugs (fibrates, statins). Moreover, PPARγ agonists and in development PPARα/γ agonists are promising for the treatment of diabetic hyperlipidemia.