Type 2 Diabetes Adult Outpatient Insulin Guidelines - CMA Foundation

In addition to recommending primary preventive strategies that include therapeutic lifestyle
modifications and lipid modifying medications, healthcare providers should evaluate patients for
preventable secondary causes of dyslipidemia that include:
• Chronic renal failure
• Diabetes
• Hypothyroidism
• Obstructive liver disease
• Medications that affect LDL and HDL cholesterol levels, including:
o Progestins
o Corticosteroids
o Anabolic steroids
There have been a number of recent clinical trials demonstrating that lowering LDL cholesterol
levels using secondary prevention strategies can also help reduce the risk of developing major
cardiovascular disease. Secondary prevention of dyslipidemia focuses on decreasing the
overall risk of developing cardiovascular disease, acute coronary events, stroke, and mortality in
people identified with chronic heart disease by lowering LDL cholesterol to a level less than 100
mg/dL by: 34
• Increase or intensify lifestyle modifications
• Recommend weight loss and increased physical activity for people with risk factors
• Delay use or intensification of LDL lowering medication and institute treatment of other lipid
or non-lipid risk factors
• Consider use of other lipid modifying drugs to treat elevated triglyceride or low HDL
cholesterol
Most lipid problems associated with a chronic illness are hereditary, and early consideration of
lifelong medication management is important. Although lifestyle modification, diet and exercise
are effective in combination with the use of pharmacotherapy, diet and exercise alone do not
correct the underlying genetic disorder. Lowering LDL cholesterol levels through the use of
secondary prevention strategies in combination with appropriate lifestyle modifications can
greatly reduce an individual’s risk of developing diabetes related complications, experience
cardiovascular events and premature mortality.
46 CMA FoundAtion . diAbetes And CArdiovAsCulAr diseAse Provider reFerenCe guide . july 2011