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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #90: Lipid and Lipoprotein Metabolism, Hypolipidemic Agents, and Therapeutic Goals Part 2

Lipoprotein metabolism in normal individuals and in type 2 diabetes mellitus: Triglyceride levels in blood are regulated by the size and number of VLDL secreted from the liver and the efficiency with which triglycerides are cleared from the plasma by lipoprotein lipases. In T2DM, greater numbers of larger, more triglyceride-enriched VLDL are secreted from the liver and lipoprotein lipase activity may be modestly reduced; both lead to increased levels of triglyceride in the blood. HDL cholesterol levels are reduced for several reasons, including increased transfer of that cholesterol to very low- and low-density lipoprotein, in exchange for their triglyceride, by cholesterol ester transfer protein. LDL particles lose some of their cholesterol to VLDL via the same exchange mechanism, which generate smaller, denser, LDL.

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Impaired Renal Function

Test Your Knowledge

At her last visit, your patient’s labs showed a eGFR 55 ml/min/1.73 m2. At this visit, her labs measured an eGFR of 44 ml/min/1.73 m2. Dose reduction/cessation should be considered for all of the following agents EXCEPT: A. Glyburide B. Sitaglipitin C. Metformin D. Pioglitazone Follow the link for the correct answer.

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Prediabetes Drug Recommendations

What percentage of your prediabetes patients do you recommend a pharmaceutical treatment? 1. 10-25% 2. 25-50% 3. Greater than 50% 4. Zero. I only recommend diet and exercise. Follow the link to share your response.

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Current Interview: Leigh Perreault

Dr. Leigh Perreault is an associate professor of medicine, physician and clinical researcher at the University of Colorado Denver School of Medicine, Aurora, CO. Her overarching research interest lies in understanding the different pathways by which people develop type 2 diabetes, and developing tailored strategies for diabetes prevention. Complementing her independent research interests, Dr. Perreault works closely with collaborators examining emerging risk factors for diabetes such as sleep restriction, intramuscular lipids and the human microbiome.

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