A fasting (8-hour fast) lipid profile (TC, HDL-C, TG, and calculated LDL-C) or nonfasting lipid profile (apo B, non-HDL-C calculation) should be measured at the time of diagnosis of diabetes. If lipid-lowering treatment is not initiated, repeat testing is recommended yearly. More frequent testing (every 3–6 months) should be performed after treatment for dyslipidemia is initiated.
For patients with indications for lipid-lowering therapy , treatment should be initiated with a statin, to achieve LDL-C ≤2.0 mmol/L.
In patients achieving goal LDL-C with statin therapy, the routine addition of fibrates or niacin for the sole purpose of further reducing CV risk should not be used.
For individuals not at LDL-C target despite statin therapy as described above, a combination of statin therapy with second-line agents may be used to achieve the LDL-C goal.
For those who have serum TG >10.0 mmol/L, a fibrate should be used to reduce the risk of pancreatitis while also optimizing glycemic control and implementing lifestyle interventions (e.g. weight loss, optimal dietary strategies, reduction of alcohol).
Abbreviations:
apo B, apolipoprotein
B; CV, cardiovascular;
HDL-C, high-density lipoprotein cholesterol;
LDL-C, low-density lipoprotein cholesterol;
TC, total cholesterol;
TG, triglyceride.
