Management of Hyperglycemia and Dyslipidemia

Introduction to Management

The American College of Cardiology recommends that management for patients with hyperglycemia, hypertriglyceridemia, low HDL cholesterol, and mildly impaired renal function should begin with lifestyle modifications and a statin, followed by consideration of fibrate therapy if triglycerides remain elevated 1, 2

A fasting glucose level indicating prediabetes places the patient at increased risk for cardiovascular disease (CVD) and chronic kidney disease (CKD), as noted by the American College of Cardiology 2
The American Diabetes Association suggests that an HDL cholesterol level below the recommended level of >40 mg/dL is associated with increased cardiovascular risk 4
A triglyceride/HDL ratio indicating significant insulin resistance is a concern for patients with hypertriglyceridemia, according to the American College of Cardiology 2

The American Diabetes Association recommends implementing dietary changes focusing on reduction of saturated fat, trans fat, and cholesterol intake, as well as increasing omega-3 fatty acids, viscous fiber, and plant stanols/sterols in the diet 5
The American College of Cardiology suggests recommending weight loss if the patient is overweight/obese, and increasing physical activity to improve insulin sensitivity and lipid profile 1, 4
Limiting alcohol consumption and completely avoiding it if triglycerides remain elevated is recommended by the American College of Cardiology 1

The American Diabetes Association recommends starting metformin as first-line therapy for prediabetes to improve glycemic control, which will help reduce triglyceride levels 2, 6
Considering GLP-1 receptor agonists if the patient is overweight/obese, as these can improve both glycemic control and lipid parameters, is suggested by the American College of Cardiology 2

The American College of Cardiology recommends initiating moderate-intensity statin therapy as first-line treatment for both LDL reduction and moderate triglyceride lowering 2, 5
If triglycerides remain >200 mg/dL after 3 months of statin therapy and optimal glycemic control, considering adding fenofibrate is recommended by the American Diabetes Association 4
Monitoring for potential myositis with statin-fibrate combination therapy is advised by the American Diabetes Association 7

The American Diabetes Association suggests checking lipid panel and glycemic parameters every 3 months until targets are achieved, with target goals of triglycerides <150 mg/dL, HDL >40 mg/dL, and LDL <100 mg/dL 4

Improved glycemic control can be very effective for reducing triglyceride levels and should be aggressively pursued, according to the American Diabetes Association 7

Failing to address underlying hyperglycemia before adding lipid-lowering medications is a common pitfall, as noted by the American Diabetes Association 7
Overlooking the increased risk of myositis with statin-fibrate combinations is a concern, according to the American Diabetes Association 7