Time for more active lipid-lowering treatment of patients with diabetes. Negative effect of hyperlipidemia on beta-cells is a neglected field

Type 2 diabetes mellitus is a common metabolic disorder whose prevalence is increasing in the western world. The ravaging complications of the disease constitute a major cause of hospitalisation and cardiovascular morbidity, and despite intensive research the pathogenic mechanism remain unknown. The article summarises some recent advances in the field of islet beta-cell dysfunction caused by hyperlipidaemia in the diabetic state, which results in perturbed insulin secretory capacity and overt glucose intolerance. In contrast to hyperglycaemia, the detrimental effects of hyperlipidaemia have been a relatively neglected area of diabetes research. However, the direct inhibitory effects of long-term hyperlipidaemia on beta-cell function, 'lipotoxicity,' should form the basis of a more active approach to lipid screening and pharmacological treatment of hyperlipidaemia in diabetes patients. Intervention in the leptin pathway may prove beneficial in future treatment strategies.