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

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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):
1. at diagnosis of diabetes
2. if <40 years old and not on a statin, consider annual lipid panel
3. at age 40 if not yet on a statin to establish treatment baseline
4. 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

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

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.