Funded out Association’s general revenues and does not use industry support. Funded out Association’s general revenues and does not use industry support

Pregnant patients:

• Pregnant patients:

• In pregnant patients with diabetes and chronic hypertension, blood pressure targets of 120–160/80–105 mmHg are suggested in the interest of optimizing long-term maternal health and minimizing impaired fetal growth. E

Patients with BP >120/80 should be advised on lifestyle changes to reduce BP. B

• Patients with BP >120/80 should be advised on lifestyle changes to reduce BP. B

• Patients with confirmed BP >140/90 should, in addition to lifestyle therapy, have prompt initiation and timely subsequent titration of pharmacological therapy to achieve blood pressure goals. A

Patients with confirmed office-based blood pressure >160/100mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of two drugs or a single pill combination of drugs demonstrated to reduce cardiovascular events in patients with diabetes. A

• Patients with confirmed office-based blood pressure >160/100mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of two drugs or a single pill combination of drugs demonstrated to reduce cardiovascular events in patients with diabetes. A

• Lifestyle intervention including:

• Weight loss if overweight
• DASH-style diet
• Moderation of alcohol intake
• Increased physical activity

Treatment for hypertension should include A

• Treatment for hypertension should include A

• ACE inhibitor
• Angiotensin II receptor blocker (ARB)
• Thiazide-like diuretic
• Dihydropyridine calcium channel blockers

• Multiple drug therapy (two or more agents at maximal doses) generally required to achieve BP targets.

An ACE inhibitor or angiotensin receptor blocker, at the maximum tolerated dose indicated for blood pressure treatment, is the recommended first-line treatment for hypertension in patients with diabetes and urinary albumin–to– creatinine ratio >300 mg/g creatinine (A) or 30–299 mg/g creatinine (B). If one class is not tolerated, the other should be substituted. B

• An ACE inhibitor or angiotensin receptor blocker, at the maximum tolerated dose indicated for blood pressure treatment, is the recommended first-line treatment for hypertension in patients with diabetes and urinary albumin–to– creatinine ratio >300 mg/g creatinine (A) or 30–299 mg/g creatinine (B). If one class is not tolerated, the other should be substituted. B

If using ACE inhibitors, ARBs, or diuretics, monitor serum creatinine / eGFR & potassium levels. B

• If using ACE inhibitors, ARBs, or diuretics, monitor serum creatinine / eGFR & potassium levels. B

In adults not taking statins, a screening lipid profile is reasonable (E):

• In adults not taking statins, a screening lipid profile is reasonable (E):

• At diabetes diagnosis
• At the initial medical evaluation
• And every 5 years, or more frequently if indicated

• Obtain a lipid profile at initiation of statin therapy, and periodically thereafter. E

To improve lipid profile in patients with diabetes, recommend lifestyle modification A, focusing on:

• To improve lipid profile in patients with diabetes, recommend lifestyle modification A, focusing on:

• Weight loss (if indicated)
• Reduction of saturated fat, trans fat, cholesterol intake
• Increase of ω-3 fatty acids, viscous fiber, plant stanols/sterols
• Increased physical activity

Intensify lifestyle therapy & optimize glycemic control for patients with: C

• Intensify lifestyle therapy & optimize glycemic control for patients with: C

• Triglyceride levels >150 mg/dL (1.7 mmol/L) and/or
• HDL cholesterol <40 mg/dL (1.0 mmol/L) in men and <50 mg/dL (1.3 mmol/L) in women

• For patients with fasting triglyceride levels ≥ 500 mg/dL (5.7 mmol/L), evaluate for secondary causes and consider medical therapy to reduce the risk of pancreatitis. C

In clinical practice, providers may need to adjust intensity of statin therapy based on individual patient response to medication (e.g., side effects, tolerability, LDL cholesterol levels). E

• In clinical practice, providers may need to adjust intensity of statin therapy based on individual patient response to medication (e.g., side effects, tolerability, LDL cholesterol levels). E

• Ezetimibe + moderate intensity statin therapy provides add’l CV benefit over moderate intensity statin therapy alone; consider for patients with a recent acute coronary syndrome w/ LDL ≥ 50mg/dL A or in patients with a history of ASCVD who can’t tolerate high-intensity statin therapy. E

Combination therapy (statin/fibrate) doesn’t improve ASCVD outcomes and is generally not recommended A. Consider therapy with statin and fenofibrate for men with both trigs ≥204 mg/dL (2.3 mmol/L) and HDL ≤34 mg/dL (0.9 mmol/L). B

• Combination therapy (statin/fibrate) doesn’t improve ASCVD outcomes and is generally not recommended A. Consider therapy with statin and fenofibrate for men with both trigs ≥204 mg/dL (2.3 mmol/L) and HDL ≤34 mg/dL (0.9 mmol/L). B

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