DYSLIPIDEMIA VS HYPERGLYCEMIA

Abstract

Preventive CardiologyVolume 10, Issue 2 p. 112-112 Free Access DYSLIPIDEMIA VS HYPERGLYCEMIA First published: 10 May 2007 https://doi.org/10.1111/j.1520-037X.2007.05719.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat To the Editor: The article by Gosavi et al1 on lipid management in patients with diabetes and prediabetes deserves comment. The article implies that in such patients, diabetes and prediabetes are the premier conditions the treating physician should be concerned about and that the dyslipidemia is a secondary condition. As a physician who directs an aggressive dyslipidemia screening and treatment clinic, I would argue that the reverse is true. I screen everyone for whom I can find a reason to screen—and any reason is a good reason—for dyslipidemia with a full lipid panel and for glucose intolerance with a test of the 2-hour postprandial blood sugar level (2-hour BSL). I treat primarily on the basis of the presence of dyslipidemia; if the 2-hour BSL is high, then I also treat the blood glucose level with diet and exercise, although not with medication until the 2-hour BSL is ≥200 mg/dL. Thus, I see the entire spectrum of dysglycemia: normoglycemia (defined as 2-hour BSL ≤124 mg/dL), impaired glucose tolerance (prediabetes, defined as 2-hour BSL of 125–199 mg/dL), and diabetes (defined as 2-hour BSL ≥200 mg/dL). The concept of prediabetes (what I term impaired glucose tolerance) is a useless concept because it focuses attention on an elevated glucose level, which does not per se lead to macrovascular disease. Indeed, in my experience, no one with impaired glucose tolerance has any type of atherothrombotic disease (ATD) unless he/she had at least 1 of the major ATD risk factors: cigarette smoking, dyslipidemia, and hypertension.2 Diet and exercise are the most effective ways to treat impaired glucose tolerance, and yet one sees providers such as nurse practitioners treating elevated insulin levels (even if the patient is normoglycemic) with metformin. Diet and exercise have a role to play in treating mild dyslipidemia and mild hypertension, but failure to achieve treatment goals for dyslipidemia or hypertension only delays the onset of ATD. Similarly, only 1% of my male patients with diabetes and 9% of my female patients with diabetes developed a clinical ATD event in the absence of at least 1 of the 3 major ATD risk factors listed above.2 Those diabetics who have never smoked cigarettes live a normal lifespan (average age of death for men is 78 years and for women is 77 years), and only 56% of my patients with diabetes who have ATD die of a recurrent ATD event.2 I have no cases of end-stage renal disease and only a few cases of minimal retinopathy in my patients with diabetes. My main reason in writing is a philosophical one. I am concerned that physicians—and worse, nurse practitioners and physician assistants—will get bogged down in the concept of prediabetes and give more emphasis to blood sugar levels and less emphasis to the associated dyslipidemia, hypertension, and cigarette smoking. I know that Gosavi et al understand the points I have made here. As I wrote, my purpose in writing is a philosophical one—I believe that physicians active in the war against ATD should not lose sight of the main treatment goals (optimization of treatment for dyslipidemia and hypertension and cessation of cigarette smoking) while following the emperor-without-any-clothes blood sugar levels of impaired glucose tolerance (prediabetes).—William E. Feeman Jr, MD, Bowling Green, OH References 1 Gosavi A, Flaker G, Gardner D. Lipid management reduces cardiovascular complications in individuals with diabetes and prediabetes. Prev Cardiol. 2006; 9: 102– 107. Wiley Online LibraryCASPubMedGoogle Scholar 2 Feeman WE Jr. Decreased cardiovascular death rate in diabetes with cardiovascular disease. Presented at: 2003 Annual Scientific Assembly of the American Academy of Family Physicians; October 15, 2003; New Orleans, LA. Google Scholar Volume10, Issue2Spring 2007Pages 112-112 ReferencesRelatedInformation