Ask the Experts - A Patient With Type 2 Diabetes and Dyslipidemia
Ask the Experts - A Patient With Type 2 Diabetes and Dyslipidemia
A 40-year-old patient recently diagnosed with type 2 diabetes presents with blood levels of glucose 240 mg/dL, triglycerides 5000 mg/dL, and total cholesterol 750 mg/dL. After 10 days of treatment with diet, exercise, metformin, and fenofibrate, glucose levels decreased to 100 mg/dL and seemed controlled, but lipid levels remained high (triglycerides 328 mg/dL, total cholesterol 326 mg/dL, low-density lipoproteins 220 mg/dL, and high-density lipoprotein 51 mg/dL).
Should I add atorvastatin or continue with the present regimen for some time?
This patient has a dual illness with both type 2 diabetes and dyslipidemia. It is somewhat surprising that the fall in cholesterol was so disproportionate to that in triglycerides levels, with the latter usually responding much less rapidly than was the case here. Alcohol and/or dietary factors may have been responsible for some of the initial picture.
Therefore, I would be particularly cautious about instituting combination statin/fibrate treatment immediately and would wait several more weeks. An option at that point might be to switch to atorvastatin rather than giving it initially in combination with fenofibrate, but recognizing that this might ultimately be required. Consideration should also be given to niacin treatment, because doses of no more than 2 g per day, which is usually well tolerated in terms of glycemia, would address both the triglyceride and cholesterol abnormalities.
A 40-year-old patient recently diagnosed with type 2 diabetes presents with blood levels of glucose 240 mg/dL, triglycerides 5000 mg/dL, and total cholesterol 750 mg/dL. After 10 days of treatment with diet, exercise, metformin, and fenofibrate, glucose levels decreased to 100 mg/dL and seemed controlled, but lipid levels remained high (triglycerides 328 mg/dL, total cholesterol 326 mg/dL, low-density lipoproteins 220 mg/dL, and high-density lipoprotein 51 mg/dL).
Should I add atorvastatin or continue with the present regimen for some time?
This patient has a dual illness with both type 2 diabetes and dyslipidemia. It is somewhat surprising that the fall in cholesterol was so disproportionate to that in triglycerides levels, with the latter usually responding much less rapidly than was the case here. Alcohol and/or dietary factors may have been responsible for some of the initial picture.
Therefore, I would be particularly cautious about instituting combination statin/fibrate treatment immediately and would wait several more weeks. An option at that point might be to switch to atorvastatin rather than giving it initially in combination with fenofibrate, but recognizing that this might ultimately be required. Consideration should also be given to niacin treatment, because doses of no more than 2 g per day, which is usually well tolerated in terms of glycemia, would address both the triglyceride and cholesterol abnormalities.
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