Clinical Care of Lipids in People with Type 1 Diabetes

Abstract

Early assessment of cardiovascular risk and aggressive risk factor control are essential for reducing the burden of atherosclerotic cardiovascular disease (ASCVD) in people with type 1 diabetes mellitus (T1DM). ASCVD is the major cause of death in people with T1DM, and people diagnosed in early childhood and people with diabetic kidney disease are at particularly high risk. Dyslipidemia is a major modifiable ASCVD risk factor contributing to atherosclerosis, which begins earlier and progresses more rapidly in people with T1DM. Glycemic variability, lipid variability, and hypoglycemia may also promote atherosclerosis. Quantitative and qualitative abnormalities in the lipoprotein profile can occur in people with T1DM with hyperglycemia or even when glycemia is well controlled. As well as poor glycemic control, the presence of obesity or renal dysfunction can worsen the traditional lipid profile, such that it more closely resembles that of people with type 2 diabetes. However, there remains a relative paucity of T1DM-specific clinical trial data to inform lipid management guidelines, which often makes the clinical care of lipids in people with T1DM challenging. This chapter provides an overview of ASCVD risk assessment, lipid screening, setting of lipid goals, use of statin and non-statin therapies for lipid lowering, and barriers to optimal lipid care in people with T1DM. Keywords Diabetes mellitus Type 1 diabetes Dyslipidemia Lipids Cardiovascular diseases Diabetes complications Lipid-lowering therapy