Frank Lavernia, MD, offers his clinical perspectives on personalized therapy considerations in the case of an overweight 47-year-old man with poorly controlled diabetes and dyslipidemia.

Cohen RV, Pinheiro JC, Schiavon CA, Salles JE, Wajchenberg BL, Cummings DE. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care. 2012;35:1420-1428. The authors of the current prospective study sought to examine the potential benefits of laparoscopic Roux-en-Y gastric bypass (LRYGB) among those with BMI 30-34.9 kg/m² (class I obesity) and type 2 diabetes.

Exclusive! Video commentary from Vivian A. Fonseca, MD. ORIGIN Trial Investigators, Bosch J, Gerstein HC, et al. ORIGIN: Omega-3 Fatty Acid and CVD Outcomes in Patients with Dysglycemia. N Engl J Med. 2012;367(4):309-318. The Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial is a randomized, double-blind trial with a 2X2 factorial design that enrolled 12,537 patients who were at high risk for CV events and who had IFG, IGT, or newly diagnosed diabetes.

Ai M, Otokozawa S, Schaefer EJ, et al. Glycated albumin and direct low density lipoprotein cholesterol levels in type 2 diabetes mellitus. Clin Chimica Acta.. 2009;406(1-2):71-74. Diabetes mellitus is a major risk factor for coronary heart disease (CHD), renal failure, retinopathy, and neuropathy. Lowering glycosylated hemoglobin (HbA1c) as well as low-density lipoprotein-cholesterol (LDL-C) has been associated with a decreased risk of these complications.

Gatti A, Maranghi M, Bacci S, et al. Poor glycemic control is an independent risk factor for low HDL cholesterol in patients with type 2 diabetes. Diabetes Care. 2009;32(8):1550-1552. To determine whether the association observed between poor glycemic control and low HDL cholesterol in type 2 diabetes is dependent on obesity and/or hypertriglyceridemia.

Gatti A, Maranghi M, Bacci S, et al. Poor glycemic control is an independent risk factor for low HDL-C in patients with type 2 diabetes. Diabetes Care. 2009 Jun 1. [Epub ahead of print]. To determine whether the association observed between poor glycemic control and low HDL-Cholesterol (HDL-C) in type 2 diabetes is dependent on obesity and/or hypertriglyceridemia.

Després JP. Pleiotropic effects of rimonabant: clinical implications. Curr Pharm Des. 2009;15(5):533-570. Abdominal obesity (high waist circumference) is more strongly associated with cardiovascular disease and type 2 diabetes than generalized adiposity (high body mass index).

Bansal S, Buring JE, Rifai N, Mora S, Sacks FM, Ridker PM. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA. 2007;18;298(3):336-8. The association of triglycerides with incident cardiovascular disease remains controversial. Although triglyceride levels are typically obtained in the fasting state, postprandial hypertriglyceridemia may play an important role in atherosclerosis.

Rosenson RS, Wolff DA, Huskin AL, Helenowski IB, Rademaker AW. Fenofibrate therapy ameliorates fasting and postprandial lipoproteinemia, oxidative stress, and the inflammatory response in subjects with hypertriglyceridemia and the metabolic syndrome. Diabetes Care. 2007 Aug;30(8):1945-51. Epub 2007 May 4. OBJECTIVE: The aim of this study was to determine the effects of fenofibrate (160 mg/day) on fasting and postprandial lipoproteins, oxidized fatty acids, and inflammatory mediators in subjects with hypertriglyceridemia and the metabolic syndrome.

Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S. Adults. Diabetes Care. 2004;27:2444-2449. The prevalence of the metabolic syndrome is high among U.S. adults. Our purpose was to determine whether the prevalence of this syndrome has changed since 1988-1994.