Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011854 (type 1 diabetes)
 20,749 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of lipid-lowering drugs in diabetes is aimed primarily at reducing the large cardiovascular disease (CVD) risk burden experienced by this group of patients. Statin therapy has been shown to be highly efficacious in reducing CVD risk, both in those with and without prior CVD. Therefore, statins are the first-line lipid-lowering therapy in patients with diabetes. Patients with diabetes and established CVD should have low-density lipoprotein cholesterol (LDLC) lowered to at least 2.6 mmol/L (100 mg/dL) and, if possible, to 1.8 mmol/L (70 mg/dL). Those without prior CVD should have LDLC lowered to 2.6 mmol/L. Triglycerides should be kept less than 1.7 mmol/L (150 mg/dL) and high-density lipoprotein cholesterol (HDLC) above 1.15 mmol/L (40 mg/dL) in men and 1.2 mmol/L (46 mg/dL) in women. Additional therapy with fibrates or nicotinic acid may be needed to achieve these goals; the choice is determined by tolerance and side-effect profile. The use of nicotinic acid or fibrates on their own to achieve triglyceride or HDLC levels should be limited to those patients already at or near LDLC goals. Caution is warranted with combination therapy because muscle side effects, in particular, can increase. In type 1 diabetes, CVD risk is high but trial data are sparse. Where there is nephropathy, and where glycemic control is poor, there will often be a need for triglyceride and HDLC raising interventions as above. In the absence of these, lipid profile is often normal and focus should be on reducing CVD risk by statin therapy. If uncertainty about CVD risk status exists, consideration should be given to using CVD imaging modalities to inform intervention choice in younger patients.
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PMID:Treatment of lipid disorders in patients with diabetes. 1640 82

Patients with diabetes mellitus are at increased risk of cardiovascular disease (CVD). Dyslipidemia, an important component of the insulin resistance syndrome and type 2 diabetes, is strongly related to CVD risk and is open to therapeutic intervention. Statins have proved to be safe, very-well tolerated, and highly effective in reducing the levels of LDL cholesterol and apolipoprotein B. Primary and secondary CVD prevention trials have shown that use of statins leads to highly significant reductions in the incidence of major CVD events. A wealth of data on the outcomes of statin therapy is now available to guide clinical practice in the population of patients with type 2 diabetes. Statin therapy in patients with type 1 diabetes seems to have a similar benefit to that seen in patients with type 2 diabetes. However, despite statin therapy, high CVD risk persists in these populations. More-intensive statin therapy produces greater reduction in the incidence of CVD events, but a more-global approach to lipid management is likely to result in further risk reduction. After reductions in the levels of LDL cholesterol and apolipoprotein B, the next target of lipid-lowering therapy is to increase HDL-cholesterol levels, which tend to be low in patients with type 2 diabetes. The most effective HDL-cholesterol-raising agent currently available for use in clinical practice is niacin. Trials with surrogate end points have pointed to the cardiovascular benefit of adding niacin to statin therapy. Large CVD end point trials, which include many patients with diabetes, are underway to test the combination of a statin and niacin versus a statin alone.
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PMID:Lipid control in patients with diabetes mellitus. 2140 58

Low rates of statin prescribing have been noted in several major studies of patients with schizophrenia and the aim of this study was to investigate clinicians' attitudes to prescribing statins to different patient groups. The general practitioners (GPs) in Dumfries and Galloway were randomized into two groups. They received an email invitation to a web-based survey. The survey asked for treatment recommendation for three patient vignettes, each with a 10-year cardiovascular risk of 20%. In one group descriptions of the patient included type 1 diabetes, epilepsy and unemployed and in the other group these were replaced by type 2 diabetes, schizophrenia and retired. The questionnaires had no other differences. After three email invites, 53 questionnaires were completed (40% of a potential 133 participants). Statin therapy was recommended by 88% and 85% of respondents for patients with type 1 and type 2 diabetes, respectively; by 37% of respondents for patients with schizophrenia and 31% for patients with epilepsy; by 33% of respondents for retired patients and 23% of respondents for patients who are unemployed. This study demonstrates under-prescribing of statins. This was not worse for patients with schizophrenia as compared with patients with epilepsy. This suggests that the low rates of treatment of metabolic risk factors in patients with schizophrenia are not the result of clinician bias when compared with patients with epilepsy. Clinician bias, however, may reduce the chances of an unemployed patient receiving statin treatment.
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PMID:Survey of general practitioners' attitudes to prescribing statins in different patient groups: a web-based survey. 2151 31