Statins and Type 2 Diabetes

Effects of treatment with pravastatin, atorvastatin, and pitavastatin examined….

It is well known that type 2 diabetes is a risk factor for cardiovascular (CV) and cerebrovascular diseases. Many patients with type 2 diabetes have concurrent dyslipidemia and metabolic syndrome that is managed by statin therapy.

A recent review examined the literature evidence from a variety of research studies linking statin therapy to type 2 diabetes. It was found that some statin therapies have been associated with diabetogenic effects and increased risk of new-onset type 2 diabetes. While statin therapy has been shown to reduce the number of CV events overall, it also has shown variable increases in fasting blood glucose (FBG) and HbA1c.

A post hoc analysis of data from the PROVE-IT TIMI 22 trial showed an increase in HbA1c of 0.12% and 0.30% in patients without type 2 diabetes taking pravastatin 40mg, and atorvastatin 80mg, respectively (P<0.0001). Alternatively, the CAPITAIN study showed that 6 months of treatment with pitavastatin 4mg had no effect on mean FPG, HbA1c, or insulin/glucose ratios in patients with metabolic syndrome. Furthermore, LIVALO revealed a 0.28% decrease in HbA1c levels in patients with type 2 diabetes treated with pitavastatin.

The review concludes that different statin therapies may have varying effects on patient FBG and HbA1c levels, with pitavastatin showing a neutral or even beneficial effect.

Practice Pearls:

• The US FDA has changed labeling on statin medications to include the possible effect of HbA1c and FBG increases.
• The literature suggests that the CV benefit from statin therapy may continue to outweigh the risk of diabetes.
• Statins are recommended to remain a first-line therapy for most patients with dyslipidemia, metabolic syndrome and type 2 diabetes.

Diabetes/Metabolism Research & Reviews 2014. [Ray, Kausik. Statin diabetogenicity: guidance for clinicians. Cardiovascular Diabetology. 2013;12(Suppl 1):S3]