TABLE 2.
DM Risk Management and Treatment Goals
| ADA (79,80) | ACC/AHA (3,4,6) | ESC (81) | |
|---|---|---|---|
| HgA1c | Goal <7.0% | <7.0% | <7.0% <6.5% if achievable without hypoglycemia Less stringent in elderly patients |
| HTN | Goal of <140/90 mm Hg Goal of <130/80 mm Hg if high risk of CVD |
BP goal of <130/80 mm Hg Initiate treatment if BP >130/80 mm Hg (specific DM recommendations) |
SBP target 130 mm Hg <130 mm Hg if tolerated but not <120 mm Hg In older patients (age >65 yrs) SBP goal 130–139 mm Hg DBP goal <80 mm Hg but not <70 mm Hg |
| LDL | <40 yrs no ASCVD risk factor—no statin <40 yrs ASCVD risk factors—high-intensity statin ≥40 yrs no ASCVD risk factor—moderate-intensity statin ≥40 yrs ASCVD risk factor—high-intensity statin |
>40 yrs of age, moderate-intensity statin regardless of 10-yr ASCVD risk DM patients with multiple ASCVD risk factors, it is reasonable to prescribe high-intensity statin therapy with the aim to reduce LDL-C levels by 50% or more Age 20 to 39 yrs of age with DM that is either of long duration (≥10 yrs of type 2 diabetes mellitus, ≥20 yrs of type 1 diabetes mellitus), albuminuria (≥30 μg of albumin/mg creatinine), estimated glomerular filtration rate <60 ml/min/1.73 m2, retinopathy, neuropathy, or ankle-brachial index (<0.9), it may be reasonable to initiate statin therapy |
Very high-risk LDL <55 mg/dl or LDL 50% reduction High risk <70 mg/dl or LDL 50% reduction Moderate risk <100 mg/dl |
| Aspirin | DM who are at increased risk of CVD | No specific DM recommendations | Only in very high risk/high risk |
ADA Definition: ASCVD risk factors—LDL ≥100 mg/dl, high blood pressure, smoking, chronic kidney disease, albuminuria, and family history of premature ASCVD. ESC Definition: Very high risk—target organ damage or 3 or more risk factors or type 2 DM duration >20 years. High risk—DM >10-yr duration without target organ damage, and any other risk factor. Moderate risk—type 1 DM and <35 years of age, type 2 DM <50 years of age with DM <10 yrs duration without risk factor.
ACC = American College of Cardiology; ADA = American Diabetes Association; AHA = American Heart Association; ASCVD = atherosclerotic cardiovascular disease; BP = blood pressure; CVD = cardiovascular disease; DBP = diastolic blood pressure; DM = diabetes mellitus; ESC = European Society of Cardiology; HgA1c = hemoglobin HgA1c; HTN = hypertension; LDL = low-density lipoprotein; SBP = systolic blood pressure.