For diabetes patients, practical recommendations would be:

Start moderate-intensity statin therapy if:
- Young — age 20-39 with microvascular complications or long-standing DM.
- Older— age 40-75 without major risk factors.
Start high-intensity statin ± ezetimibe if the following factors are present with the goal of reducing LDLc ≥50%:
- Who are already on statin therapy, it is reasonable to continue statin therapy.
- It may be reasonable to initiate statin therapy after a clinician–patient discussion of potential benefits and risks
In ALL adults with diabetes mellitus and:
- Multiple ASCVD risk factors, it is reasonable to prescribe high-intensity statin with the goal of reducing LDLc ≥50%
- 10-year ASCVD risk of ≥20%, it may be reasonable to add ezetimibe to maximally tolerated statin therapy to reduce LDLc ≥50%
- Multiple risk factors
- ASCVD 10YR ≥20%
For adults >75, clinician-patient discussion is needed if statin were to be started or continued.

CIRCULATION

LIPID GUIDELINES

In adults age 20-39 with diabetes mellitus + the following condition, it may be reasonable to start moderate statin therapy:

Long duration of diabetes
- ≥10 years of diabetes type 2
- ≥20 years of diabetes type 1
Microvascular disease:
- Nephropathy
  - Albuminuria ≥30
  - eGFR <60
- Retinopathy
- Neuropathy
Macrovascular disease:
- ABI <0.9

In adults age 40-75 with diabetes mellitus:

Irrespective of 10-year ASCVD risk, at least moderate-intensity statin is indicated.
If LDLc is 70-189 mg/dL, it is reasonable [but not necessary] to assess the 10-year ASCVD risk by using race and sex-specific ASCVD calculators.

In adults age >75 with diabetes mellitus:

Who are already on statin therapy, it is reasonable to continue statin therapy.
It may be reasonable to initiate statin therapy after a clinician–patient discussion of potential benefits and risks

In ALL adults with diabetes mellitus and:

Multiple ASCVD risk factors, it is reasonable to prescribe high-intensity statin with the goal of reducing LDLc ≥50%
10-year ASCVD risk of ≥20%, it may be reasonable to add ezetimibe to maximally tolerated statin therapy to reduce LDLc ≥50%