Diabetes guidance 1766.pdf - East Cheshire NHS Trust
Diabetes guidance 1766.pdf - East Cheshire NHS Trust Diabetes guidance 1766.pdf - East Cheshire NHS Trust
Lipid TherapyLipidsAll patients with Type 1 and Type 2 diabetes aged >40 years should be viewed as at high risk ofcardiovascular disease (CVD) and should be offered a statin. The Heart Protection Study (HPS) showedthat these patients benefited from simvastatin 40 mg at night for primary prevention if they had a totalcholesterol level >3.5 mmol/L.Total and LDL CholesterolIdeally, lipids should be measured on a 12-hour fasting sample, but this can be impractical in diabetes.Total and HDL cholesterol can be measured with reasonable accuracy on a random sample, providingtriglycerides do not exceed 2.2 mmol/L.Secondary causes of lipid abnormalities such as excess alcohol, hypothyroidism and liver disease shouldbe investigated and managed in those with significant hypercholesterolaemia (>7.5 mmol/L) and/orhypertriglyceridaemia (>4.0 mmol/L).NICE (2009 CG87) recommends to treat to achieve total cholesterol of
Lipids - continuedHDL Cholesterol and TriglyceridesLow HDL cholesterol (2.2 mmol/L) are both independent riskfactors for CVD.The first priority in patients with raised triglycerides is to improve diet and glycaemic control, as insulinresistance often increases levels.Statins remain the cornerstone of lipid-lowering therapy, but consider adding a fibrate if fasting triglyceridesexceed 2.2 mmol/L despite optimal statin therapy and adequate glycaemic control.Earlier addition of a fibrate may be appropriate if triglycerides are high (>4.0 mmol/L) despite goodglycaemic control. It may be appropriate to discuss these patients with a diabetologist or lipidologist.Fenofibrate as Supralip 160 mg daily is the preferred fibrate choice.In mild/moderate renal impairment (CKD stages 3 or 4), exercise caution in using fibrates because of anincreased risk of rhabdomyolysis. In these cases a lower dose of fenofibrate as Lipantil Micro may be used.Fibrates are contra-indicated in severe renal disease (CKD stage 5).Specialist ReferralConsider discussion with or referral to a lipidologist or diabetologist if:• Familial hypercholesterolaemia is a possibility;• Satisfactory targets are not reached, despite intervention as outlined above;• HDL cholesterol is significantly decreased (10 mmol/L) due to the risk of pancreatitis.
- Page 1 and 2: Eastern CheshireVale RoyalSouth Che
- Page 3 and 4: The Newly Diagnosed Diabetic Patien
- Page 5 and 6: Glycaemic ControlHbA1c MeasurementH
- Page 7 and 8: Self-Monitoring of Blood Glucose -
- Page 9 and 10: Glycaemic Control in Type 2 Diabete
- Page 11 and 12: Insulin therapy - continuedPatients
- Page 13: HypertensionBP targets are the same
- Page 17 and 18: Screening for Diabetic NephropathyS
- Page 19 and 20: Active Foot DiseaseUlcerRefer to Sp
Lipids - continuedHDL Cholesterol and TriglyceridesLow HDL cholesterol (2.2 mmol/L) are both independent riskfactors for CVD.The first priority in patients with raised triglycerides is to improve diet and glycaemic control, as insulinresistance often increases levels.Statins remain the cornerstone of lipid-lowering therapy, but consider adding a fibrate if fasting triglyceridesexceed 2.2 mmol/L despite optimal statin therapy and adequate glycaemic control.Earlier addition of a fibrate may be appropriate if triglycerides are high (>4.0 mmol/L) despite goodglycaemic control. It may be appropriate to discuss these patients with a diabetologist or lipidologist.Fenofibrate as Supralip 160 mg daily is the preferred fibrate choice.In mild/moderate renal impairment (CKD stages 3 or 4), exercise caution in using fibrates because of anincreased risk of rhabdomyolysis. In these cases a lower dose of fenofibrate as Lipantil Micro may be used.Fibrates are contra-indicated in severe renal disease (CKD stage 5).Specialist ReferralConsider discussion with or referral to a lipidologist or diabetologist if:• Familial hypercholesterolaemia is a possibility;• Satisfactory targets are not reached, despite intervention as outlined above;• HDL cholesterol is significantly decreased (10 mmol/L) due to the risk of pancreatitis.
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