Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.
Guidelines
- All hypercholesterolaemic diabetics should be treated with 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitor to retard progression of nephropathy. (Level III evidence for Type 1 diabetes; Level II evidence for Type 2 diabetes - small volume of data) There is no evidence on which to base recommendations for target total cholesterol, low-density lipoprotein (LDL), high density lipoprotein (HDL) or triglyceride levels.
- All diabetic patients should receive statin therapy for cardiovascular protection. (Level I evidence)
Suggestions for Clinical Care
(Suggestions are based on Level III and IV sources)
In the absence of evidence to guide target lipid levels for renal endpoints, it is reasonable to follow the recommendations of the National Heart Foundation and the Australian Diabetes Association Guidelines - recommend fasting total cholesterol level < 5.0 mmol/L, LDL < 3.0 mmol/L.
Definitions:
Levels of Evidence
Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)
Level II: Evidence obtained from at least one properly designed RCT
Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group
Level IV: Evidence obtained from case series, either post-test or pretest/post-test
