Diabetes Standards of Care & Clinical Practice Resources
Lipid Management
Cardiovascular disease (CVD) is a major cause of morbidity and mortality for individuals with diabetes. Appropriate use of statin therapy results in significant CVD risk reduction for adults with diabetes.
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Lipid Management Sections
Quickly jump to a section on this page by clicking on one of the links below.
- Section 1 – Clinical Practice Recommendations: Lipid Management
- Section 2 – Clinician and Educator Resources: Lipid Management
- Section 3 – Patient Education Resources: Lipid Management
Clinical Practice Recommendations
Recommendations for Lipid Management
Measurement
- Order a lipid panel (total cholesterol, LDL, HDL, triglycerides):
- at diagnosis of diabetes
- if <40 years old and not on a statin, consider annual lipid panel
- at age 40 if not yet on a statin to establish treatment baseline
- as needed every 1-2 years (e.g., to evaluate adherence to lipid therapy)
- See Diabetes Treatment Algorithm: Lipid and Aspirin Therapy in Type 2 Diabetes.
Treatment
- Implement a treatment plan to achieve lipid management goals:
- Lifestyle Therapy: Lifestyle therapy, including nutrition and physical activity, weight management, and smoking cessation, is indicated for all patients with type 2 diabetes, even those with "normal" lipid levels.
- Statin Therapy: Medication recommendations can be found in the Diabetes Treatment Algorithm: Lipid and Aspirin Therapy in Type 2 Diabetes.
Statin Treatment Recommendations for People with Diabetes
The most effective pharmacologic lipid treatment to reduce risk for CVD events is statin therapy. For patients who cannot tolerate a particular statin, it is reasonable to try using a different statin. If no statin is tolerated, consider a non-statin medication to lower LDL cholesterol; however, there is little evidence of CVD benefit from non-statin lipid medications.
For all patients with diabetes, initiate lifestyle therapy, then:

Lifestyle therapy
1 CVD Risk Factors include: LDL ≥100mg/dL, High Blood Pressure, Smoking, or Overweight/Obesity
2 Overt CVD includes people with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization).
3 Statin Therapy:
- Moderate Intensity: Atorvastatin 10-20 mg, Simvastatin 20-40 mg, Pravastatin 40mg, Lovastatin 40-80 mg, Fluvastatin 80 mg, Rosuvastatin 5-10 mg
- High intensity: Atorvastatin 40-80 mg, Rosuvastatin 20-40 mg
For a text description of the information in the diagram above:
- Initiate lifestyle therapy for all patients with diabetes.
- Patients <40 years of age:
- Without CVD risk factors1, should not receive statin therapy.
- With CVD risk factors1, should receive moderate or high intensity statin therapy3.
- With overt CVD2, should receive high intensity statin therapy3.
- Patients 40-75 years of age:
- Without CVD risk factors1, should receive moderate intensity statin therapy3.
- With CVD risk factors1, should receive high intensity statin therapy3.
- With overt CVD2, should receive high intensity statin therapy3.
- Patients >75 years of age:
- Without CVD risk factors1, should receive moderate intensity statin therapy3.
- With CVD risk factors1, should receive moderate or high intensity statin therapy3.
- With overt CVD2, should receive high intensity statin therapy3.
1 CVD Risk Factors include: LDL ≥100mg/dL, High Blood Pressure, Smoking, or Overweight/Obesity
2 Overt CVD includes people with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization).
3 Statin Therapy:
- Moderate Intensity: Atorvastatin 10-20 mg, Simvastatin 20-40 mg, Pravastatin 40mg, Lovastatin 40-80 mg, Fluvastatin 80 mg, Rosuvastatin 5-10 mg
- High intensity: Atorvastatin 40-80 mg, Rosuvastatin 20-40 mg
Notes:
- Check liver function before starting statin therapy and monitor periodically as indicated.
- Statins are contraindicated in pregnancy and nursing mothers. Consider pregnancy risk when prescribing statins for reproductive age women.
Clinician and Educator Resources
Diabetes Treatment Algorithm: Lipid and Aspirin Therapy in Type 2 Diabetes
IHS Diabetes Treatment and Prevention
2018 AHA/ACC Guideline on the Management of Blood Cholesterol
Circulation Nov 2018; doi:10.1161/CIR.0000000000000625
American Diabetes Association Standards of Medical Care in Diabetes – 2020
Diabetes Care 2020;43(Supplement 1):S111-S134. doi:10.2337/dc20-S010
Update on Prevention of Cardiovascular Disease in Adults with Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement from the American Heart Association and the American Diabetes Association [PDF]
Diabetes Care 2015 Sep; 38 (9) 1777-1803; doi: 10.2337/dci15-0012
LIPIDS Pocket Guide Card [PDF]
VA/DoD Clinical Guidelines: The Management of Dyslipidemia for Cardiovascular Risk Reduction (Lipids)
Department of Veterans Affairs
American College of Cardiology
Framingham Heart Study Cardiovascular Disease (10-year Risk)
National Heart, Lung, and Blood Institute and Boston University
Calculator: Estimated Risk of Developing CHD in 10 Years
Strong Heart Study
Patient Education Resources
Prevention and Treatment of High Cholesterol
American Heart Association
Taking Care of Your Diabetes Means Taking Care of Your Heart
National Diabetes Education Program