Statins promote the progression of type 2 diabetes

/roger ashford, stock.adobe.com

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Dallas, Texas – Starting statin therapy can make it difficult to control blood sugar in type 2 diabetes. The consequence may be an increase in the number of prescribed antidiabetic drugs or even the need for insulin therapy, as a study in JAMA Internal Medicine (2021; DOI: 10.1001/jamainternmed.2021.5714) shows.

It is known that statins make the body’s insulin less effective and raise blood sugar levels. An increase in the number of new cases was observed in the approval studies for the individual statins, which is why the risk is pointed out in the product information.

It was unclear how the treatment would affect patients who already had type 2 diabetes. Since these people are usually excluded from participating in the registration studies, the question can only be clarified through epidemiological studies. A commonly used source is data from the United States Veterans Administration (VA).

Ishak Mansi of the “VA North Texas Health System” compared 83,022 couples of type 2 diabetics who were largely identical in all characteristics, except for the new statin prescription, which occurred as a result of increased cholesterol levels. Such “propensity score” analyzes are intended to simulate the conditions of a randomized study, in which the equality of the participants is ensured through the random distribution.

The quality of a propensity score analysis depends on the number of known patient characteristics. Because the US veterans receive high quality medical treatment, the information in the medical records is detailed and usually reliable.

Mansi found that there was a deterioration in blood sugar control for the first 5.3 years of statin use. This was expressed in a 16% increase in the number of patients who had to start insulin treatment (odds ratio OR 1.16; 95% confidence interval 1.12 to 1.19).

The number of patients who had to increase the number of their (other) antidiabetic drugs increased by 41% (OR 1.41; 1.38 to 1.43). Blood sugar levels of 200 mg / dl or higher (OR 1.13; 1.10 to 1.16) were 13% more common, and severe derailments with ketoacidosis were 24% more common (OR 1.24; 1.19 to 1.30).

These risks must of course be weighed against the benefits of better cholesterol levels, which the study also documents. The statin users lowered their mean LDL cholesterol by 25 mg / dl, which in the long term can lower the cardiovascular risk, which is increasing in diabetics.

The risk-benefit balance for statin use should therefore generally be positive. However, according to the prescription, doctors should regularly check the blood sugar of their patients in order to be able to adjust the dose of the medication in good time. © rme / aerzteblatt.de

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