For last week’s practice question, we quizzed participants on the new ADA Standards for lipid management. It was a complicated question and 43% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question:
JR is 67 with type 1 diabetes and was discharged a few months ago after receiving a coronary artery bypass. JR is on insulin pump therapy and a CGM, with a recent A1C of 6.7%. Their blood pressure is 129/78.
Other recent labs include:
- LDL cholesterol of 67 mg/dL
- HDL 54 mg/dL
- Triglycerides 172 mg/dL
- UACR 23 mg/g GFR 61
JR’s medications include: insulin, atorvastatin 80mg, atenolol 50mg, and aspirin therapy. JR has met with the dietitian and is trying to eat healthfully. They have lost 5 pounds over the past few months.
Based on the 2023 ADA Standards of Care and JR’s history, which of the following is considered best practice?
Answer Choices:
- Add an ACE or ARB
- Keep LDL cholesterol less than 70 mg/dL
- Increase fiber intake by 20%
- Add ezetimibe (Zetia) or a PCSK9
Getting to the Best Answer
Answer 1 is incorrect. 23.93% chose this answer, “Add an ACE or ARB.” This was a juicy answer. However, since the B/P is on target at less than 130/80 and JR does not have an elevated UACR, adding an ACE or ARB is not indicated at this time.
Answer 2 is incorrect. 21.08% of you chose this answer, “Keep LDL cholesterol less than 70 mg/dL.” Since JR has ASCVD, as evidenced by their need for a coronary artery bypass, the LDL target is less than 55 mg/dL. This new intensified LDL target is based on the 2023 updated guidelines. Read our blog on New Lipid Guidelines here.
Answer 3 is incorrect. 11.99% of respondents chose this answer, “Increase fiber intake by 20%.” While increasing fiber intake is always a good idea, in may not be enough to help JR get their LDL to a target level of less than 55 mg/dl.
Finally, Answer 4 is correct. 42.96% chose this answer, “Add ezetimibe (Zetia) or a PCSK9.” Yes, this is the best answer, GREAT JOB. Since JR has ASCVD, as evidenced by their need for a coronary artery bypass, the LDL target is less than 55 mg/dL. Since they are already on max dose of atorvastatin at 80mg, the ADA Guidelines recommend adding an additional agent, either ezetimibe (Zetia) or a PCSK9 to further lower the LDL to reach a target of less than 55 mg/dL. Download Lipid Medication Cheat Sheet Here
Thank you so much for reading this “Rationale of the Week”. For more information on this topic, we encourage you to Read our blog on New Lipid Guidelines and Download Lipid Medication Cheat Sheet Here. We also invite you to join our Online Courses and Virtual DiabetesEd Training Program.
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