Lipoprotein metabolism in diabetes mellitus.

Abstract

Diabetes mellitus is almost always associated with changes in plasma lipoproteins.To understand the mechanism of the changes in lipoproteins that occur in diabetes mellitus and how they may influence the development of the cardiovascular disease that accompanies this disorder, we must examine lipoprotein metabolism.The purpose of this review is to summarize observations from this and other laboratories on lipoprotein metabolism in human diabetics, to evaluate the possible mechanisms of diabetes-associated changes in lipoprotein metabolism, and to define directions for future research.As will be evident, there are multiple abnormalities of lipoprotein metabolism, primarily in VLDL and HDL, but also to some extent in LDL, which can potentially explain the increased atherogenesis in human diabetics.This review will consider separately studies of lipoprotein metabolism in the two major forms of human diabetes as defined by the National Diabetes Data Group (1) and the World Health Organization (2).The two forms of diabetes differ in their basic mechanisms of development and in physiologic characteristics such as associations with obesity, age, and insulin; thus, lipoprotein metabolism may differ in the two forms.It should be emphasized, however, that the two forms of this disease share the common characteristics of hyperglycemia and both microvascular and macrovascular complications, and it is possible that lipoproteins are related to the etiology of the cardiovascular disease in the two forms of diabetes in similar ways. LIPOPROTEIN METABOLISM IN NON-INSULIN-DEPENDENT DIABETES MELLITUSThe most common form of human diabetes is non-insulin-dependent diabetes (NIDDM); this is also referred to as Type 11, maturity onset, or non-ketotic diabetes (1, 2).It most often occurs after age 40, and is very often associated with obesity.Individuals with NIDDM I.11.