Dyslipidemia ÎAll patients with DM should be screened for dyslipidemia (A-1).
ÎTherapeutic recommendations should include therapeutic lifestyle changes and, as needed, consultation with a registered dietitian and/or CDE (A-1).
ÎPharmacologic 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
> 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.
cholesterol absorption inhibitors should be considered in situations of inadequate goal attainment. These agents may be used instead of statins in cases of statin- related adverse events or intolerance (A-2).
Table 9. Classification of Dyslipidemiaa Level
Very high High
Borderline high Normal,
desirable, or near optimal
Low Optimal Target in DM
< 100 < 100
consider < 70
LDL mg/dL HDL mg/dL ≥ 190
160-189 130-159
100-129 ≥ 60
≥ 40 < 35
> 40 (men) > 50 (women)
Triglycerides mg/dL
≥ 500
200-499 150-199
< 150 ≥ 240
200-239 < 200
Total-C mg/dL
< 150
< 200
a Risk for CVD or coronary heart disease increases with increasing levels of LDL, Total-C, and triglycerides, and with decreasing levels of HDL.
Depression ÎRoutine 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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