statins

The American Diabetes Association has published its Standards of Medical Care in Diabetes (2015), which includes new guidance on statin treatment.

The new guidelines recommend most people with diabetes to be put on statins. The main exception to this is in people with diabetes under 40 years old that have no other risk factors for heart disease aside from diabetes.

Statin dose recommendations

The following table details the recommendations for people with diabetes across different age group and heart risk profiles.

Age Heart risk Recommended statin dose
Under 40 years old None
Risk factors
Heart disease
None
Moderate or high dose
High dose
40 to 75 years old None
Risk factors
Heart disease
Moderate dose
High dose
High dose
Over 75 years old None
Risk factors
Heart disease
Moderate dose
Moderate or high dose
High dose

Risk factors are defined as:

  • High LDL cholesterol
  • High blood pressure
  • Smoking
  • Being overweight or obese

Is the medicalization justified?

Research shows that for every 1,000 people taking statins for three years 7 non-fatal heart attacks, 4 strokes and 2 deaths are prevented. The other side of the argument is that lifestyle changes could achieve a similar or better result without the side effects that include blood sugar levels, memory loss and myopathy (muscle weakage and pains).

Other changes in the Standards of Medical Care in Diabetes 2015

The Standards of Medical Care in Diabetes includes 14 sections, of which management of heart risk is just section.

Other notable changes in the document include a lower BMI cut off point of 23 kg/m2 for Asian Americans, an HbA1c target of 7.5% for children and adolescents with diabetes and an increase in the diastolic blood pressure target to 140/90 mm/Hg.