The American Diabetes Association (ADA) recommends that all adult patients with diabetes have their lipid profile determined yearly. This profile includes total cholesterol, HDL cholesterol, triglycerides, and calculated LDL cholesterol. If the triglyceride level is high a direct LDL measurement should be strongly considered. If values are at low-risk levels (LDL <100 mg/dl, triglycerides <150 mg/dl, and HDL >50 mg/dl), assessment may be repeated every 2 years.

ADA guidelines for serum lipid levels in patients with diabetes are shown in Table 3. In Table 4 are shown the ADA recommendations for treating LDL cholesterol levels. The NCEP III definition of lipid levels is shown in Table 5 and the updated NCEP III recommendations (2004) for LDL levels in patients with diabetes (and other high risk patients) is shown in Table 6. There is now agreement that the LDL goal in all adult patients with diabetes is less than 100 mg/dl. If the LDL is greater than 100 mg/dl one should institute life style changes and drug therapy to reduce the LDL levels. Thus, no adult diabetic patients should have an LDL greater than 100 mg/dl. If one follows the ADA recommendations in patients greater than 40 years of age if the total cholesterol is greater than 135mg/dl one would begin statin therapy with the aim of lowering the LDL cholesterol by 30+ percent regardless of initial LDL levels. Thus many patients with LDL levels less than 100mg/dl will still require statin therapy. If one follows the NCEP guidelines one will aim for LDL cholesterol less than 70mg/dl in high risk patients with diabetes. For example, in a patient with diabetes and known clinical coronary heart disease an LDL goal of less than 70 is clearly indicated. Similarly, in diabetic patients with many other risk factors that put them at particularly high risk for cardiovascular disease an LDL goal of less than 70 may also be warranted. Thus in integrating the two guidelines it is clear that an LDL of less than 100mg/dl is the goal in all adult diabetic patients. Very high risk patients should have LDL levels less than 70mg/dl. As recommended by the ADA it is likely that statin therapy is indicated in almost all patients over the age of 40 with diabetes. Thus statin therapy has become an integral part of the treatment plan of patients with diabetes.