Dyslipidemia
ÎÎAll patients with DM should be screened for dyslipidemia (A-1).
ÎÎTherapeutic recommendations should include therapeutic lifestyle
changes and, as needed, consultation with a registered dietitian
and/or CDE (A-1).
ÎÎPharmacologic therapy is used to achieve targets unresponsive to
therapeutic lifestyle changes alone.
>> LDL-C is the primary target for therapy.
>> Statins are the treatment of choice in the absence of contraindications.
>> Combinations of statins (A-1) with bile acid sequestrants, niacin, and/or
cholesterol absorption inhibitors should be considered in situations of inadequate
goal attainment. These agents may be used instead of statins in cases of statinrelated adverse events or intolerance (A-2).
>> In patients with LDL-C at goal but with triglyceride concentrations of 200 mg/dL
or higher or low HDL-C (< 35 mg/dL), treatment protocols including the use of
fibrates or niacin are used to achieve non–HDL-C goal:
▶▶ < 100 mg/dL when at highest risk (A-1).
▶▶ < 130 mg/dL when at high risk (A-1).
▶▶ Apolipoprotein B targets are less than 80 mg/dL in patients with CVD and less
than 90 mg/dL in patients without CVD.
Table 9. Classification of Dyslipidemiaa
Level
LDL mg/dL
Very high
160-189
Borderline high
100-129
Low
Optimal
Target in DM
a
≥ 60
200-499
≥ 240
150-199
200-239
< 150
< 200
< 150
< 200
130-159
Normal,
desirable, or
near optimal
Triglycerides
mg/dL
≥ 190
High
HDL mg/dL
Total-C
mg/dL
≥ 500
≥ 40
< 35
< 100
< 100
> 40 (men)
consider < 70 > 50 (women)
Risk for CVD or coronary heart disease increases with increasing levels of LDL, Total-C, and
triglycerides, and with decreasing levels of HDL.
Depression
ÎÎRoutine depression screening is recommended for adults with DM (A-1).
Note: Untreated comorbid depression can have serious clinical implications for
patients with DM.
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