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Pérez et al¹ recently reported the high proportion of patients with poorly controlled type 1 diabetes mellitus who manifest low levels of high-density lipoprotein cholesterol and high levels of low-density lipoprotein cholesterol. These abnormalities improved with intensified insulin therapy, which the authors suggested obviated the need for other pharmacologic and nonpharmacologic treatment of dyslipidemia. Further, they advocate that intensive insulin therapy be considered the initial treatment of choice for dyslipidemia associated with poorly controlled type 1 diabetes mellitus.

There are a number of limitations to this recommendation. It is based solely on achieving lipid goals by using a therapy (insulin) that has not been convincingly shown (even in the Diabetes Control and Complications Trial²) to reduce macrovascular events in subjects with either type 1 or type 2 diabetes mellitus.³ The trend toward improving macrovascular events in subjects with type 2 diabetes mellitus in the UK Prospective Diabetes Study (UKPDS) . . . [Full Text of this Article]