Therapeutic options for lowering LDL-C in type 2 diabetes: A nurse practitioner's perspective

Authors

  • Kelley Newlin Lew DNSc, APRN-C, CDE,

    (Assistant Professor), Corresponding author
    • School of Nursing, University of Connecticut, Storrs, Connecticut
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  • Daniel J. Kent PharmD, CDE,

    (Clinical Specialty Coordinator, Infectious Disease/Endocrinology; Diabetes/HIV Integrated Health Consultant)
    1. Pharmacy Administration Group Health, University of Washington, Seattle, Washington
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  • Angelica A. Muñoz PharmD, CDE,

    (Senior Medical Liaison)
    1. Daiichi Sankyo, Inc, Parsippany, New Jersey
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  • Gail D'Eramo Melkus EdD, C-NP, FAAN

    (Florence and William Downs Professor in Nursing Research)
    1. Muriel and Virginia Pless Center for Nursing Research, New York University College of Nursing, New York, New York
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  • Disclosures Bret Fulton and Sushma Soni of inScience Communications, Springer Healthcare, provided medical writing support funded by Daiichi Sankyo, Inc. KNL has been a consultant for Daiichi Sankyo, Inc.

  • DJK has no conflicts of interest to declare. AAM is employed by Daiichi Sankyo, Inc. GDM has been a consultant for Daiichi Sankyo, Inc.

Correspondence

Kelley Newlin Lew, DNSc, APRN-C, CDE, School of Nursing, University of Connecticut, Storrs Hall, 231 Glenbrook Road, Storrs, CT 06269.

Tel: 860-486-5537; Fax: 860-233-5039; E-mail: kelley.newlin_lew@uconn.edu

Abstract

Purpose

The majority of patients with type 2 diabetes mellitus (T2DM) have multiple risk factors for cardiovascular disease (CVD). Low-density lipoprotein cholesterol (LDL-C) is a key therapeutic target to reduce CVD risk. This article reviews therapeutic strategies that nurse practitioners (NPs) may use in the management of patients with T2DM requiring lipid management.

Data sources

The evidence used in developing this review included evidence-based reviews, clinical trials, guidelines, and consensus statements. Relevant publications were identified through a search of the literature using PubMed and other search engines.

Conclusions

Lowering LDL-C levels may reduce CVD risk, but achieving goals can be challenging. Lifestyle modifications (including diet, exercise, and smoking cessation) are key components of lipid management and reduction of CVD risk. Statins can be effective to reduce lipids. However, patients may not achieve lipid goals with monotherapy or may experience intolerable adverse effects. Alternative statins or statins along with other lipid-lowering agents remain good options.

Implications for practice

Achieving LDL-C goals requires a comprehensive treatment plan that incorporates lifestyle and pharmacologic interventions. Patient commitment in setting goals and self-management is essential. NPs can play an important role in educating patients as well as prescribing appropriate treatments.

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