Diabetes
10
4. Type 1 Diabetes Mellitus
➤ 4.1 In adults with type 1 diabetes (T1D) age 40 years and older and/or
with duration of diabetes greater than 20 years, and/or microvascular
complications, we suggest statin therapy, irrespective of the CV risk score,
to reduce CV risk. (2|⊕
)
Technical Remarks:
▶ LDL should be the primary target for lipid-lowering therapy.
▶ Consider therapy if LDL is over 70 mg/dl (1.8 mmol/L).
▶ Statins should not be used in women who are pregnant or trying to become pregnant.
➤ 4.2 In adults with T1D with CKD in stages 1–4, we suggest statin therapy,
irrespective of the CV risk score, to reduce CV risk. (2|⊕
)
Technical Remarks:
▶ LDL should be the primary target for lipid-lowering therapy.
▶ Consider therapy if LDL is over 70 mg/dL (1.8 mmol/L).
▶ When selecting the statin, consider the renal clearance of the statin: Pitavastatin,
pravastatin and rosuvastatin all have at least partial clearance through the kidney
whereas atorvastatin, fluvastatin, lovastatin, and simvastatin are cleared via the
liver.
▶ All statins require dose adjustments in CKD except for atorvastatin and fluvastatin.
▶ Ezetimibe can be added to the statin if required to lower LDL-C further. No dose
adjustments of ezetimibe are needed in CKD.
➤ 4.3 In adults with T1D with obesity, or with high TG and low high-density
lipoprotein cholesterol (HDL-C), we suggest statin therapy, irrespective of
the CV risk score, to reduce CV risk. (2|⊕
)
Technical Remarks:
▶ LDL should be the primary target for lipid-lowering therapy.
▶ Consider therapy if LDL is over 70 mg/dL (1.8 mmol/L).
➤ 4.4 In adults with T1D and diabetic retinopathy, we suggest statin therapy,
irrespective of the CV risk score, to reduce CV risk. (2|⊕
)
Technical Remarks:
▶ LDL should be the primary target.
▶ Consider therapy if LDL-C is over 70 mg/dL (1.8 mmol/L).
