The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice

Sattar NA, Ginsberg H, Ray K, et al.
Atherosclerosis Supplements, Volume 15, Issue 1, June 2014, Pages 1-15

The benefit of statins is evident in a wide range of patient populations. Although they are generally safe, use of statins has been associated with an increased risk of developing type 2 diabetes (T2D). Because of this, the US Food and Drug Administration (FDA) now requires statins to include a warning on their label about the possibility of increased blood sugar and HbA1c levels. For the same reason, the European Medicines Agency (EMA) issued guidance on a small increased risk of T2D with use of statins.

A group of physicians not only reviewed the evidence that lead to these claims, and what different guidelines recommend in case of dyslipidaemia or T2D. Most importantly, they provide practical guidance for primary care physicians on the use of statins in people with or at risk of developing T2D. Suggestions are given on which steps to take in order to assess CVD risk, T2D risk, and based on the outcomes, which tests to perform. The recommendations are illustrated with clinical cases.

Evidence from clinical studies on the diabetogenicity of statins is discussed, as well as the mechanistic rationale for these effects. Furthermore, the available data on whether all statins exert diabetogenic effects are outlined, leading to the conclusion that more research is needed to understand which is the best treatment for people with or at high risk of developing statin-mediated T2D. Also, it remains to be elucidated whether the diabetogenic effects of statins are similar across all patient groups.

While the risk of developing T2D exists, they conclude that the benefits of statins for the reduction of CV risk far outweigh the risk of developing T2D, especially when CV risk is high. It is recommended to assess T2D risk in all patients before statin therapy is started. Patients should be educated about the risks, and encouraged to reduce their risk by lifestyle changes. This should limit the risk of transitioning from prediabetes to T2D.
Patients at high risk of developing T2D should be monitored regularly, to detect possible changes in blood glucose or HbA1c levels. In case a patient develops T2D during statin treatment, the authors recommend continuation of statin therapy, and management of T2D according to relevant national guidelines.

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