COMMENTARY

How Do New Statin Guidelines Affect Diabetes Care?

Anne L. Peters, MD

Disclosures

November 21, 2013

In This Article

A Problem for Patients With Diabetes

Now, that takes me back to the patients with diabetes. One of the problems with lumping people with type 1 and type 2 diabetes together is that although both are at higher risk, we don't really know what that true risk is, particularly in individuals with type 1 diabetes. I don't think that type 1 and type 2 diabetes share similar features, or at least not similar features with regard to the metabolic syndrome in all patients. Therefore, as I ponder these guidelines, I find myself also pondering about my individual patients.

Just this week, I had a patient who came into the office. He is lean, his body mass index is 20 kg/m2, and he has had type 1 diabetes for many years. He is in his 50s, and he runs 5 miles a day. He is not hypertensive. In fact, his blood pressure is 110/70 mm Hg without any medication. He has no diabetes complications, and his LDL cholesterol is 73 mg/dL, with an HDL of 75 mg/dL. I also measured his C-reactive protein level, which was very low. Coronary calcium scanning showed no coronary calcium.

So in this particular individual, even though the guidelines would say that he should be on a statin because his LDL is above 70 mg/dL, I looked at him, discussed this with him, and decided not to treat with a statin -- at least not yet -- because his risk appears to be fairly low.

But for many of our patients with diabetes, the risk is high. Most of my patients with type 2 diabetes have the metabolic syndrome, are at higher risk for cardiovascular disease, and benefit from statin therapy.

I think the hardest thing is going to be trying to get over testing lipids all the time. My patients and I love numbers. I'm a diabetes specialist. I look at numbers all the time. We look at self-monitoring of blood glucose values, we look at A1c levels, and my patients love to look at their lipid panels to know how they are doing.

So I think I will still monitor lipid panels. Perhaps not for absolute numbers, but to see that a patient is responding to therapy -- maybe as a marker for the fact that my patients are taking their therapy, and also to reinforce patients with some of the benefit from the treatments and lifestyle changes they have made, which I think can still be had along with the use of statin therapy in these high-risk individuals.

This has been Dr. Anne Peters for Medscape. Thank you.

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