Polypharmacy in T2DM: Which Drugs Affect the Lipid Profile?

Polypharmacy is extremely common in the population of individuals with diabetes
Polypharmacy is extremely common in the population of individuals with diabetes

Atherosclerosis is considered to be the major cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM), and atherogenic dyslipidemia is a key contributor to lipid-related cardiovascular (CV) risk in patients with insulin resistance.1 Conversely, poor glycemic control increases the risk of all-cause mortality and atherosclerotic cardiovascular disease (ASCVD); and even in the presence of good glycemic control, patients with either type 1 diabetes mellitus (T1DM) or T2DM have twice the mortality risk, compared with the general population.1 Additional vulnerability to ASCVD experienced by patients with diabetes include a combination of “accelerating risk factors,” including hypertension, chronic kidney disease, and insulin resistance/hyperinsulinemia, all of which are associated with varying degrees of dyslipidemia.1 For this reason, it is essential for patients with diabetes to have a favorable lipid profile. 

Some antidiabetic agents can adversely affect lipid profile, as can other commonly prescribed agents, such as antihypertensives, weight loss medications, antibiotics, analgesics, oral contraceptives, and hormone replacement therapy (HRT). A recently published article by Paul Rosenblit, MD1 reviews these agents and their impact on “routine lipid profile.”

The findings of the review are summarized in the Tables.

The Role of Polypharmacy

The author noted that polypharmacy is extremely common in the population of individuals with diabetes, emphasizing that the “effects on the lipid profile, whether significant or nominal for any single agent, should not be considered in isolation, since most patients will be taking multiple medications from various classes to treat multiple comorbidities.”1 For this reason, “even if the impact of a given medication on lipid profile is relatively minimal, and therefore unlikely to independently affect ASCVD risk, the cumulative effect is important and cannot be overlooked.”

Clinical Implications

“It is important to observe the overall changes governing the ultimate management of dyslipidemia to reduce ASCVD risk,” the author advised. “Clinicians can help to ensure optimal care and avoid putting patients at unnecessary risk by performing ongoing lipid-panel monitoring, taking into account potential effects of commonly prescribed medications.” He concluded that, ultimately, “lifestyle recommendations and lipid-lowering agents are required to target atherogenic cholesterol and achieve the appropriate goals determined by the absolute risk for the individual, especially those with a relatively absolute higher risk (ie, patients with diabetes.)”

References

1. Rosenblit PD. Common medications used by patients with type 2 diabetes mellitus: what are their effects on the lipid profile? Cardiovasc Diabetol. 2016 Jul 14;15:95.

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