0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Cholestyramine Therapy for Dyslipidemia in Non–Insulin-dependent Diabetes Mellitus: A Short-Term, Double-Blind, Crossover Trial

Abhimanyu Garg, MBBS, MD; and Scott M. Grundy, MD, PhD
[+] Article and Author Information

From the University of Texas Southwestern Medical Center at Dallas, Dallas, Texas. Requests for Reprints: Abhimanyu Garg, MBBS, MD, Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75235-9052. Grant Support: In part by a grant from Bristol-Myers-Squibb Pharmaceuticals and the National Institutes of Health grants HL-29252 and M01-RR00633. Acknowledgments: The authors thank Marjorie Whelan, Keith Lowther, Conrad Augustin, Kathy Schutt, and Christopher Clark for technical assistance and Beverley A. Huet, MS, for statistical analysis.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;121(6):416-422. doi:10.7326/0003-4819-121-6-199409150-00004
Text Size: A A A

Objective: To assess clinical efficacy and tolerability of cholestyramine therapy in patients with dyslipidemia and non–insulin-dependent diabetes mellitus (NIDDM).

Design: A randomized, double-blind, crossover study of cholestyramine (8 g twice daily) compared with placebo for a period of 6 weeks each.

Setting: Metabolic Unit and the Lipid and Diabetes Clinics at the Department of Veterans Affairs Medical Center, Dallas, Texas.

Patients: 21 patients with NIDDM that was well controlled using either glyburide or insulin therapy and with low-density lipoprotein (LDL) cholesterol levels more than 3.36 mmol/L (130 mg/dL) and fasting plasma triglyceride levels less than 3.4 mmol/L (300 mg/dL).

Measurements: During the last week of each period, for 5 consecutive days fasting plasma lipids and lipoproteins were measured, and plasma glucose levels were determined at 3, 7, and 11 a.m. and at 4 and 8 p.m. Daily urinary glucose excretion was measured for 3 days and glycosylated hemoglobin concentrations were determined on days 28 and 38 of the study periods.

Results: In this short-term study, when compared with placebo, cholestyramine reduced total cholesterol by 18% (95% CI, 14% to 22%) and LDL cholesterol by 28% (CI, 21% to 35%). Although cholestyramine therapy increased plasma triglyceride levels by 13.5% (CI, 1% to 26%), very-low-density lipoprotein cholesterol and high-density lipoprotein cholesterol levels remained unchanged. Cholestyramine therapy improved glycemic control; mean plasma glucose values were lower by 13% (CI, 5% to 21%), a median reduction in urinary glucose excretion of 0.22 g/d was observed (P < 0.001), and a tendency to lower glycosylated hemoglobin concentration was noted. The doses of glyburide and insulin did not change during the study, and body weight remained stable. Constipation was the main side effect, and two patients dropped out of the study because of cholestyramine intolerance.

Conclusions: In carefully selected male patients with NIDDM and high LDL cholesterol and normal triglyceride levels, cholestyramine therapy effectively reduces LDL levels and also may improve glycemic control. The long-term efficacy of cholestyramine therapy in patients with NIDDM needs further evaluation.

Figures

Grahic Jump Location
Figure 1.
Plasma levels of total cholesterol, low-density lipoprotein, and high-density lipoprotein measured when patients received placebo and cholestyramine.

Each symbol represents the mean of five determinations. black circles = patients with normotriglyceridemia (fasting plasma triglycerides <1.7 mmol/L [150 mg/dL]), and open circles = patients with borderline hypertriglyceridemia (fasting plasma triglyceride level of 1.7 to 3.4 mmol/L [150 to 300 mg/dL]). To convert cholesterol values to mg/dL, multiply by 38.674.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Plasma levels of triglycerides and very-low-density lipoprotein cholesterol measured when patients received placebo and cholestyramine.

Each symbol represents the mean of five determinations. black circles = patients with normotriglyceridemia (fasting plasma triglycerides <1.7 mmol/L [150 mg/dL]), and open circles = patients with borderline hypertriglyceridemia (fasting plasma triglyceride level of 1.7 to 3.4 mmol/L [150 to 300 mg/dL]). To convert cholesterol and triglycerides values to mg/dL, multiply by 38.674 and 88.574, respectively.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Levels of plasma glucose, urinary glucose, and blood glycosylated hemoglobin measured when patients received placebo and cholestyramine.

Each symbol for plasma glucose represents the mean of five daily determinations at 3, 7 and 11 a.m. and at 4 and 8 p.m. for 5 consecutive days. Each symbol for urinary glucose represents the mean of three consecutive 24-hour collections. Each symbol for glycosylated hemoglobin represents the mean of two determinations on days 28 and 38. ● =patients with normotriglyceridemia (fasting plasma triglycerides <1.7 mmol/L [150 mg/dL]), and cir; = patients with borderline hypertriglyceridemia [fasting plasma triglyceride level of 1.7 to 3.4 mmol/L (150 to 300 mg/dL)]. To convert plasma glucose values to mg/dL, multiply by 18.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)