Lipid Management in Diabetics

"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 mon- itor the response to therapy and inform adherence. (Level of Evidence: E)"

"3.Lifestyle modification focusing on weight loss (if indicated); the reduc- tion 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 opti- mize 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 dis- ease, high-intensity statin therapy should be added to lifestyle therapy. (Level of Evidence: A)"

"7.For patients with diabetes aged <40 years with additional athero- sclerotic 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 ath- erosclerotic cardiovascular dis- ease 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 athero- sclerotic 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 ther- apy alone and may be considered for patients with a recent acute cor- onary 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 tri- glyceride 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)"