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Diabetes mellitus
FATS 2 : 2000
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This is a lipid lowering drug strategy which should only be used within an
overall lifestyle and clinical management strategy. FATS2 developed in the light
of new evidence and monitoring of FATS1. FATS3 will be developed in the light of
new evidence and progress with FATS2. Agreed with the Health Authority and
primary and secondary care users.
This should be used with the supporting documentation.
Patients with CHD
- Measure total cholesterol and triglycerides.
- Prescribe if: Total cholesterol >5.0 mmol/l Drug flow: one option (see
supporting notes)
Simvastatin 10mg nocte
Simvastatin 20/40mg nocte
- Monitoring: Total cholesterol 3-4 weekly until cholesterol <5 mmol/l
Notes:
- People with diabetes and triglycerides >2.5 mmol/l consider a fibrate
(see supporting notes)
- If total cholesterol >8.0, triglycerides 4.5, or target not reached -
treat individually, consider discussion with local advisor: Newcastle:
(0191) 282 5067 North Tyneside: (0191 293 2546)
- Consider secondary causes of hyperlipidaemia - alcohol / thyroid /
diabetes / nephrotic syndrome.
- Simvastatin potentiates warfarin.
- Review compliance if cholesterol fails to fall 10-20%.
High Risk Patients without CHD
FATS advice is based on risk not cholesterol.
- Measure non fasting total cholesterol and HDL cholesterol in people with
diabetes and others at high risk of developing CHD.
- Assess:
- Age and gender
- Blood pressure
- Smoking status
- Presence or absence of diabetes
- Estimate 10 year CHD risk from coronary risk prediction chart (Joint
British Societies recommendations).
- Consider additional risk factors:
- Microalbuminuria in people with diabetes.
- Family history of premature CHD (men <55 years, women <65
years)
- Central obesity (waist >94cm men, 80cm women)
- LVH on ECG
- South Asian race
- Macro vascular disease (carotid, peripheral vascular, arterial bruits,
absent foot pulses).
If 1 additional risk factor, double
estimated 10 year CHD risk.
If 2+ additional risk factors, treble estimated 10 year CHD risk.
- Agree an overall management strategy to reduce CHD risk.
- Consider drug treatment if 10 year CHD risk is >30%.
- If considering drug treatment measure fasting total cholesterol, HDL
cholesterol and triglycerides.
- Drug flow: see under 'Patients with CHD'
- Monitoring: Total cholesterol 3-4 weekly until total cholesterol
<5mmol/l.
Notes:
- See under 'Patients with CHD'.
- LVH is already included in the computerised version of the risk assessment
charts and should not be included a second time.
Source: Northumbria NHS Health Care Trust diabetes protocol