2018 Cholesterol Guidelines: Diabetes Mellitus

For diabetes patients, practical recommendations would be:

  • Start moderate-intensity statin therapy if:

    • Young — age 20-39 with microvascular complications or long-standing DM.

    • Older— age 40-75 without major risk factors.

  • Start high-intensity statin ± ezetimibe if the following factors are present with the goal of reducing LDLc ≥50%:

    • Multiple risk factors

    • ASCVD 10YR ≥20%

  • For adults >75, clinician-patient discussion is needed if statin were to be started or continued.



Lipids Guidelines






Diabetes Mellitus in Adults

In adults age 20-39 with diabetes mellitus + the following condition, it may be reasonable to start moderate statin therapy:

  • Long duration of diabetes

    • ≥10 years of diabetes type 2

    • ≥20 years of diabetes type 1

  • Microvascular disease:

    • Nephropathy

      • Albuminuria ≥30

      • eGFR <60

    • Retinopathy

    • Neuropathy

  • Macrovascular disease:

    • ABI <0.9

In adults age 40-75 with diabetes mellitus:

  • Irrespective of 10-year ASCVD risk, at least moderate-intensity statin is indicated.

  • If LDLc is 70-189 mg/dL, it is reasonable [but not necessary] to assess the 10-year ASCVD risk by using race and sex-specific ASCVD calculators.

In adults age >75 with diabetes mellitus:

  • Who are already on statin therapy, it is reasonable to continue statin therapy.

  • It may be reasonable to initiate statin therapy after a clinician–patient discussion of potential benefits and risks


In ALL adults with diabetes mellitus and:

  • Multiple ASCVD risk factors, it is reasonable to prescribe high-intensity statin with the goal of reducing LDLc ≥50%

  • 10-year ASCVD risk of ≥20%, it may be reasonable to add ezetimibe to maximally tolerated statin therapy to reduce LDLc ≥50%

Diabetes and Dyslipidemia