Lipid Management in Diabetics: Difference between revisions
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{{ADA guidelines}} | {{ADA guidelines}} | ||
{{CMG}} {{AE}} {{SCh}}; {{MehdiP}}; {{TarekNafee}} | {{CMG}} {{AE}} {{SCh}}; {{MehdiP}}; {{TarekNafee}} | ||
==2016 ADA Standards of Medical Care in Diabetes Guidelines== | ==2016 ADA Standards of Medical Care in Diabetes Guidelines<ref name="urlcare.diabetesjournals.org">{{cite web |url=http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf |title=care.diabetesjournals.org |format= |work= |accessdate=}}</ref>== | ||
{|class="wikitable" | {|class="wikitable" | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.'''In adults not taking statins, it is reasonable to obtain a lipid profile at the time of diabetes diagnosis, at an initial medical evaluation, and every 5 years thereafter, or more frequently if indicated. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''1.'''In adults not taking statins, it is reasonable to obtain a lipid profile at the time of diabetes diagnosis, at an initial medical evaluation, and every 5 years thereafter, or more frequently if indicated. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Obtain a lipid profile at initiation of statin therapy and periodically thereafter as it may help to | | bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Obtain a lipid profile at initiation of statin therapy and periodically thereafter as it may help to monitor the response to therapy and inform adherence. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.'''Lifestyle modification focusing on weight loss (if indicated); the | | bgcolor="Seashell"|<nowiki>"</nowiki>'''3.'''Lifestyle modification focusing on weight loss (if indicated); the reduction of saturated fat, trans fat, and cholesterol intake; increase of omega-3 fatty acids, viscous fiber, and plant stanols/sterols intake; and increased physical activity should be recommended to improve the lipid profile in patients with diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.'''Intensify lifestyle therapy and | | bgcolor="Seashell"|<nowiki>"</nowiki>'''4.'''Intensify lifestyle therapy and optimize glycemic control for patients with elevated triglyceride levels (≥ 150 mg/dL [1.7 mmol/L]) and/or low HDL cholesterol (<40 mg/dL [1.0 mmol/L] for men, <50 mg/dL [1.3 mmol/L] for women. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''5.'''For patients with fasting triglyceride levels | | bgcolor="Seashell"|<nowiki>"</nowiki>'''5.'''For patients with fasting triglyceride levels ≥ 500 mg/dL (5.7 mmol/L), evaluate for secondary causes of hypertriglyceridemia and consider medical therapy to reduce the risk of pancreatitis. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''6.'''For patients of all ages with diabetes and atherosclerotic cardiovascular | | bgcolor="Seashell"|<nowiki>"</nowiki>'''6.'''For patients of all ages with diabetes and atherosclerotic cardiovascular disease, high-intensity statin therapy should be added to lifestyle therapy. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''7.'''For patients with diabetes aged <40 years with additional | | bgcolor="Seashell"|<nowiki>"</nowiki>'''7.'''For patients with diabetes aged <40 years with additional atherosclerotic cardiovascular disease risk factors, consider using moderate- intensity or high-intensity statin and lifestyle therapy. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''8.'''For patients with diabetes aged 40–75 years without additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity statin and lifestyle therapy.''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''8.'''For patients with diabetes aged 40–75 years without additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity statin and lifestyle therapy.''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
| Line 22: | Line 22: | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''9.'''For patients with diabetes aged 40–75 years with additional atherosclerotic cardiovascular disease risk factors, consider using high-intensity statin and lifestyle therapy. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''9.'''For patients with diabetes aged 40–75 years with additional atherosclerotic cardiovascular disease risk factors, consider using high-intensity statin and lifestyle therapy. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''10.''' For patients with diabetes aged >75 years without additional | | bgcolor="Seashell"|<nowiki>"</nowiki>'''10.''' For patients with diabetes aged >75 years without additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity statin therapy and lifestyle therapy ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''11.'''For patients with diabetes aged >75 years with additional | | bgcolor="Seashell"|<nowiki>"</nowiki>'''11.'''For patients with diabetes aged >75 years with additional atherosclerotic cardiovascular disease risk factors, consider using moderate- intensity or high-intensity statin therapy and lifestyle therapy. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''12.'''In clinical practice, providers may need to adjust intensity of statin therapy based on individual patient response to medication (e.g., side effects, tolerability, LDL cholesterol levels) ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''12.'''In clinical practice, providers may need to adjust intensity of statin therapy based on individual patient response to medication (e.g., side effects, tolerability, LDL cholesterol levels) ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''13.'''The addition of ezetimibe to moderate-intensity statin therapy has been shown to provide additional cardiovascular benefit compared with moderate-intensity statin | | bgcolor="Seashell"|<nowiki>"</nowiki>'''13.'''The addition of ezetimibe to moderate-intensity statin therapy has been shown to provide additional cardiovascular benefit compared with moderate-intensity statin therapy alone and may be considered for patients with a recent acute coronary syndrome with LDL cholesterol >50 mg/dL (1.3 mmol/L) or for those patients who cannot tolerate high- intensity statin therapy ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''14.'''Combination therapy (statin/fibrate) has not been shown to improve ath- erosclerotic cardiovascular disease outcomes and is generally not rec- ommended. A However, therapy with statin and fenofibrate may be considered for men with both | | bgcolor="Seashell"|<nowiki>"</nowiki>'''14.'''Combination therapy (statin/fibrate) has not been shown to improve ath- erosclerotic cardiovascular disease outcomes and is generally not rec- ommended. A However, therapy with statin and fenofibrate may be considered for men with both triglyceride level >204 mg/dL (2.3 mmol/L) and HDL cholesterol level <34 mg/dL (0.9 mmol/L) ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''15.'''Combination therapy (statin/niacin) has not been shown to provide additional cardiovascular benefit above statin therapy alone and may increase the risk of stroke and is not generally recommended ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''15.'''Combination therapy (statin/niacin) has not been shown to provide additional cardiovascular benefit above statin therapy alone and may increase the risk of stroke and is not generally recommended ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
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==References== | |||
{{Reflist|2}} | |||
{{WH}}{{WS}} | |||
Latest revision as of 20:48, 12 December 2016
|
2016 ADA Guideline Recommendations |
|
Types of Diabetes Mellitus |
|---|
|
2016 ADA Standard of Medical Care Guideline Recommendations |
|
Cardiovascular Disease and Risk Management |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4]
2016 ADA Standards of Medical Care in Diabetes Guidelines[1]
| "1.In adults not taking statins, it is reasonable to obtain a lipid profile at the time of diabetes diagnosis, at an initial medical evaluation, and every 5 years thereafter, or more frequently if indicated. (Level of Evidence: E)" |
| "2. Obtain a lipid profile at initiation of statin therapy and periodically thereafter as it may help to monitor the response to therapy and inform adherence. (Level of Evidence: E)" |
| "3.Lifestyle modification focusing on weight loss (if indicated); the reduction of saturated fat, trans fat, and cholesterol intake; increase of omega-3 fatty acids, viscous fiber, and plant stanols/sterols intake; and increased physical activity should be recommended to improve the lipid profile in patients with diabetes. (Level of Evidence: A)" |
| "4.Intensify lifestyle therapy and optimize glycemic control for patients with elevated triglyceride levels (≥ 150 mg/dL [1.7 mmol/L]) and/or low HDL cholesterol (<40 mg/dL [1.0 mmol/L] for men, <50 mg/dL [1.3 mmol/L] for women. (Level of Evidence: C)" |
| "5.For patients with fasting triglyceride levels ≥ 500 mg/dL (5.7 mmol/L), evaluate for secondary causes of hypertriglyceridemia and consider medical therapy to reduce the risk of pancreatitis. (Level of Evidence: C)" |
| "6.For patients of all ages with diabetes and atherosclerotic cardiovascular disease, high-intensity statin therapy should be added to lifestyle therapy. (Level of Evidence: A)" |
| "7.For patients with diabetes aged <40 years with additional atherosclerotic cardiovascular disease risk factors, consider using moderate- intensity or high-intensity statin and lifestyle therapy. (Level of Evidence: C)" |
| "8.For patients with diabetes aged 40–75 years without additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity statin and lifestyle therapy.(Level of Evidence: A)" |
| "9.For patients with diabetes aged 40–75 years with additional atherosclerotic cardiovascular disease risk factors, consider using high-intensity statin and lifestyle therapy. (Level of Evidence: B)" |
| "10. For patients with diabetes aged >75 years without additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity statin therapy and lifestyle therapy (Level of Evidence: B)" |
| "11.For patients with diabetes aged >75 years with additional atherosclerotic cardiovascular disease risk factors, consider using moderate- intensity or high-intensity statin therapy and lifestyle therapy. (Level of Evidence: B)" |
| "12.In clinical practice, providers may need to adjust intensity of statin therapy based on individual patient response to medication (e.g., side effects, tolerability, LDL cholesterol levels) (Level of Evidence: E)" |
| "13.The addition of ezetimibe to moderate-intensity statin therapy has been shown to provide additional cardiovascular benefit compared with moderate-intensity statin therapy alone and may be considered for patients with a recent acute coronary syndrome with LDL cholesterol >50 mg/dL (1.3 mmol/L) or for those patients who cannot tolerate high- intensity statin therapy (Level of Evidence: A)" |
| "14.Combination therapy (statin/fibrate) has not been shown to improve ath- erosclerotic cardiovascular disease outcomes and is generally not rec- ommended. A However, therapy with statin and fenofibrate may be considered for men with both triglyceride level >204 mg/dL (2.3 mmol/L) and HDL cholesterol level <34 mg/dL (0.9 mmol/L) (Level of Evidence: B)" |
| "15.Combination therapy (statin/niacin) has not been shown to provide additional cardiovascular benefit above statin therapy alone and may increase the risk of stroke and is not generally recommended (Level of Evidence: A)" |
| "16.Statin therapy is contraindicated in pregnancy. (Level of Evidence: B)" |
References
- ↑ "care.diabetesjournals.org" (PDF).