10
Diagnosis
4.3. Diabetes Mellitus in Adults
COR LOE
Recommendations
I A 1. In adults 40 to 75 years of age with diabetes mellitus,
regardless of estimated 10-year ASCVD risk, moderate-
intensity statin therapy is indicated.
IIa B-NR 2. In adults 40 to 75 years of age with diabetes mellitus and
an LDL-C level of 70 to 189 mg/dL (1.7 to 4.8 mmol/L),
it is reasonable to assess the 10-year risk of a first ASCVD
event by using the race and sex-specific PCE to help stratify
ASCVD risk.
IIa B-R 3. In adults with diabetes mellitus who have multiple ASCVD
risk factors, it is reasonable to prescribe high-intensity statin
therapy with the aim to reduce LDL-C levels by 50% or
more.
IIa B-NR 4. In adults older than 75 years of age with diabetes mellitus and
who are already on statin therapy, it is reasonable to continue
statin therapy.
IIb C-LD 5. In adults with diabetes mellitus and 10-year ASCVD risk
of 20% or higher, it may be reasonable to add ezetimibe to
maximally tolerated statin therapy to reduce LDL-C levels by
50% or more.
IIb C-LD 6. In adults older than 75 years with diabetes mellitus, it may be
reasonable to initiate statin therapy after a clinician-patient
discussion of potential benefits and risks.
IIb C-LD 7. In adults 20 to 39 years of age with diabetes mellitus that is
either of long duration (≥10 years of type 2 diabetes mellitus,
≥20 years of type 1 diabetes mellitus), albuminuria (≥30 mcg
of albumin/mg creatinine), estimated glomerular filtration
rate (eGFR) less than 60 mL/min/1.73 m
2
, retinopathy,
neuropathy, or ABI (<0.9), it may be reasonable to initiate
statin therapy.
