COMMENTARY

Anne Peters: The Year in Diabetes

Anne L. Peters, MD; Mark Harmel, MPH

Disclosures

December 10, 2013

In This Article

A Year of Small Steps

Changes in diabetes never happen as quickly as I would like, and for our patients, progress seems even slower. When I look back over the past year, I see that we have taken mostly small steps toward helping people live longer and healthier lives with diabetes. The topics discussed below seem to have had the most impact, however, on both my practice of medicine and my understanding of what might be available in the future.

New Cholesterol Guidelines

Updated cholesterol guidelines[1] from the American College of Cardiology and the American Heart Association have sparked controversy and spirited discussion about the overall management approach as well as a new online risk calculator, but few of the controversies apply to patients with diabetes.

The most significant changes for us involve stopping 2 established practices: using specific targets for patients' levels of low-density lipoprotein (LDL) cholesterol, and prescribing additional nonstatin drugs to address cardiovascular risk. But the guidelines are clear: If patients are at high risk, they need to be on statin therapy regardless of their LDL cholesterol levels. That includes all patients with diabetes between the ages of 40 and 75 years; depending on their 10-year risk for a cardiovascular event, they should be put on either a moderate-intensity or a high-intensity statin regimen. Obviously, all individuals with known cardiovascular disease are treated with a high-intensity statin regimen.

My only reservation is whether it is fair to consider patients with type 1 and type 2 diabetes in the same group, as I discussed in a recent Medscape video commentary.

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