Management of Uncontrolled Diabetes with Severe Hyperlipidemia

Glycemic Management

The American Diabetes Association recommends adding a GLP-1 receptor agonist to the current regimen for patients with type 2 diabetes and multiple cardiovascular risk factors, as this patient has hypertension, severe hyperlipidemia, and uncontrolled diabetes 1
GLP-1 receptor agonists are specifically recommended for patients with T2DM at high cardiovascular risk to reduce major adverse cardiovascular events 1
The American College of Cardiology recommends continuing dapagliflozin 10 mg as it provides cardiovascular death and heart failure risk reduction independent of glucose lowering 2
If HbA1c remains >8% after 3 months on dual therapy, the American Diabetes Association recommends adding basal insulin at a low starting dose 3

The American Heart Association states that statin therapy is the only evidence-based treatment proven to reduce cardiovascular mortality in diabetic patients with severe hyperlipidemia 3, 4
With an LDL of 231 mg/dL, the American College of Cardiology recommends high-intensity statin therapy to achieve at least a 50% reduction in LDL cholesterol 3
The target LDL cholesterol should be <100 mg/dL, and ideally <70 mg/dL given her multiple risk factors 3, 4

The American Heart Association recommends measuring blood pressure at every visit and confirming on a separate day if elevated 5, 1
The American College of Cardiology recommends a target blood pressure of <130/80 mmHg for patients with diabetes 1
First-line therapy should include an ACE inhibitor or ARB at maximum tolerated dose 5, 1

The American Heart Association recommends implementing a DASH-style dietary pattern with sodium restriction to <2,300 mg/day 7, 1
The Academy of Nutrition and Dietetics recommends limiting total fat intake to <30% of calories, with saturated fat <7% of total calories 7, 4
The American College of Sports Medicine recommends at least 150 minutes of moderate-intensity aerobic activity weekly, distributed over at least 3 days 1

The American Diabetes Association recommends rechecking HbA1c in 3 months after adding GLP-1 agonist 3
The American College of Cardiology recommends rechecking fasting lipid panel in 4-12 weeks if statin therapy is initiated 3
The American Heart Association recommends monitoring blood pressure at every visit 1