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20 April 2004 | Volume 140 Issue 8 | Pages 644-649
In an effort to provide internists and other primary care physicians with effective management strategies for diabetes care, the Clinical Efficacy Assessment Subcommittee (CEAS) of the American College of Physicians (ACP) decided to develop guidelines on the management of dyslipidemia, particularly hypercholesterolemia, in people with type 2 diabetes mellitus. The CEAS commissioned a systematic review of the currently available evidence on the management of lipids in type 2 diabetes mellitus. The evidence review is presented in a background paper in this issue. On the basis of this systematic review, the CEAS developed recommendations that the ACP Board of Regents then approved as policy.
The target audience for this guideline is all clinicians who care for patients with type 2 diabetes. The target patient population is all persons with type 2 diabetes, including those who already have some form of microvascular complication and, of particular importance, premenopausal women. The recommendations are as follows.
Recommendation 1: Lipid-lowering therapy should be used for secondary prevention of cardiovascular mortality and morbidity for all patients (both men and women) with known coronary artery disease and type 2 diabetes.
Recommendation 2: Statins should be used for primary prevention against macrovascular complications in patients (both men and women) with type 2 diabetes and other cardiovascular risk factors.
Recommendation 3: Once lipid-lowering therapy is initiated, patients with type 2 diabetes mellitus should be taking at least moderate doses of a statin.
Recommendation 4: For those patients with type 2 diabetes who are taking statins, routine monitoring of liver function tests or muscle enzymes is not recommended except in specific circumstances.
Author and Article Information
From the American College of Physicians, Philadelphia, Pennsylvania; Beth Israel Deaconess Medical Center, Boston, Massachusetts; and Hines Veterans Administration Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois.
*This paper, written by Vincenza Snow, MD; Mark D. Aronson, MD; E. Rodney Hornbake, MD; Christel Mottur-Pilson, PhD; and Kevin B. Weiss, MD, was developed by the Clinical Efficacy Assessment Subcommittee of the American College of Physicians (ACP): Kevin Weiss, MD (Chair); Mark Aronson, MD; Patricia Barry, MD; Virginia Collier, MD; J. Thomas Cross Jr., MD; Nick Fitterman, MD; E. Rodney Hornbake, MD; Douglas K. Owens, MD; and Katherine D. Sherif, MD. Approved by the ACP Board of Regents in July 2003.
Annals of Internal Medicine encourages readers to copy and distribute this paper, providing such distribution is not for profit. Commercial distribution is not permitted without the express permission of the publisher.
Note: Clinical practice guidelines are "guides" only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP clinical practice guidelines are considered automatically withdrawn, or invalid, 5 years after publication, or once an update has been issued.
Grant Support: Financial support for ACP guideline development comes exclusively from the ACP operating budget.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Vincenza Snow, MD, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, vincenza{at}acponline.org.
Current Author Addresses: Drs. Snow and Mottur-Pilson: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Aronson: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215-5400.
Dr. Hornbake: 7 Shelter Rock Road, PO Box 218, Hadlyme, CT 06439.
Dr. Weiss: Hines Veterans Administration Hospital (151H), PO Box 5000, Hines, IL 60141. CLINICAL GUIDELINES
Lipid Control in the Management of Type 2 Diabetes Mellitus: A Clinical Practice Guideline from the American College of Physicians
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