Do 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, commonly referred to as statins, increase the risk of developing diabetes mellitus?

From the Guidelines

Yes, statins can slightly increase the risk of developing type 2 diabetes, but the cardiovascular benefits of statins typically outweigh this small increased risk, especially in patients at high risk for heart disease. The risk is estimated to be about 9-12% higher in statin users compared to non-users, as noted in studies such as 1 and 1. This means that for every 255 patients treated with statins for 4 years, one additional case of diabetes might occur. The risk appears to be dose-dependent, with higher doses carrying a greater risk, as suggested by 1. However, it's essential to note that statins may unmask an underlying propensity to develop diabetes, rather than directly causing it, as mentioned in 1. If you're prescribed statins, continue taking them as directed by your doctor, and regular monitoring of blood glucose levels is recommended, especially if you have other risk factors for diabetes, as advised in 1. Lifestyle modifications, such as maintaining a healthy diet and regular exercise, can help mitigate the risk of developing diabetes while on statin therapy, as recommended in 1 and 1. Some key points to consider include:

• Statin therapy may increase the risk of type 2 diabetes in people at high risk of developing type 2 diabetes, as noted in 1.
• Glucose status should be monitored regularly, and diabetes prevention approaches reinforced, as suggested in 1.
• It is not recommended that statins be discontinued for this adverse effect, as stated in 1.
• Evaluation for tobacco use and referral for tobacco cessation should be part of routine care for those at risk for diabetes, as mentioned in 1.

From the FDA Drug Label

Increases in HbA1c and fasting serum glucose levels have been reported with statins, including atorvastatin.

Yes, HMG-CoA reductase inhibitors, commonly referred to as statins, may increase the risk of developing diabetes mellitus, as evidenced by increases in HbA1c and fasting serum glucose levels 2.

From the Research

Statins and Diabetes Risk

• The use of statins has been associated with a modest excess of type 2 diabetes mellitus in randomized trials and many observational studies 3, 4.
• High-intensity statins are associated with a higher excess risk of diabetes than moderate-intensity statins 3.
• The excess risk of diabetes appears to be confined to those who are already at risk for developing diabetes, such as individuals with pre-existing diabetogenic risk factors 3, 5.

Mechanisms of Statin-Associated Diabetes Risk

• Multiple mechanisms have been proposed for statin-associated diabetes risk, including increased insulin resistance or impaired insulin secretion 3.
• Statin impairment of insulin signaling, decreased adipocyte differentiation, and decreased pancreatic β-cell insulin secretion have also been found to contribute to the risk of diabetes 3.
• A possible explanation for the increased risk of diabetes is through a reduction in adiponectin levels 4.

Clinical Implications

• The clinical impact of statin-associated diabetes is likely unimportant, as the cardiovascular risk reduction benefit from statin far outweighs the potential for adverse effects in all but the very lowest risk individuals 3, 4.
• For every case of diabetes caused by statins, there are approximately three cardiovascular events reduced with high-dose versus moderate-dose statin therapy 4.
• The discovery and diagnosis of diabetes during statin therapy are limited to patients with multiple pre-existing diabetogenic risk factors, who would have developed diabetes with or without statin therapy 5.