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Standards of Medical Care
Lipid Management
Î In most adult patients with diabetes, measure fasting lipid profile at
least annually. (B)
Î In adults with low-risk lipid values (LDL-C <100 mg/dL, HDL-C
>50 mg/dL, and triglycerides <150 mg/dL), lipid assessments may be
repeated every 2 years. (E)
Treatment Recommendations and Goals
Î Lifestyle modification focusing on:
• Reduced saturated fat, trans fat, and cholesterol intake
• Increased n-3 fatty acids, viscous fiber, and plant stanols/sterols
• Weight loss (if indicated)
• Increased physical activity (A)
Î Statin therapy should be added to lifestyle therapy, regardless of
baseline lipid levels, for diabetic patients:
• With overt CVD (A)
• Without CVD who are over age 40 years and have ≥1 other CVD risk factors
(family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria)
(A)
Î For patients at lower risk than above (eg, without overt CVD and age
<40 years), statin therapy should be considered in addition to lifestyle
therapy if LDL-C remains >100 mg/dL or in those with multiple CVD
risk factors. (C)
Î In individuals without overt CVD, the goal is an LDL-C <100 mg/dL
(2.6 mmol/L). (B)
ÎIn individuals with overt CVD, a lower LDL-C goal of <70 mg/dL
(1.8 mmol/L), using a high dose of a statin, is an option. (B)
Î If drug-treated patients do not reach the above targets on maximum
tolerated statin therapy, a reduction in LDL-C of ~30%-40% from
baseline is an alternative therapeutic goal. (B)
Î Triglyceride levels <150 mg/dL (1.7 mmol/L) and HDL-C >40 mg/dL
(1.0 mmol/L) in men and >50 mg/dL (1.3 mmol/L) in women are
desirable. (C) However, LDL-C–targeted statin therapy remains the
preferred strategy. (A)
Î Combination therapy has been shown not to provide additional CV
benefit above statin therapy alone and is not generally recommended.
(A)
Î Statin therapy is contraindicated in pregnancy. (B)
