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[Medscape] Statins are associated with the progression of diabetes


Statin use is associated with an increased likelihood of developing diabetes, according to a cohort analysis paired with data from the US Department of Veterans Affairs.

Diabetic patients taking statins are more likely to initiate insulin, raise blood sugar, and develop acute glycemic complications, and they are also more likely to be prescribed medications from the hypoglycemic group. .

Although randomized and controlled trials have shown an association between statin use and the progression of diabetes, they often rely on measures such as insulin resistance, hemoglobin A1c, or levels fasting blood sugar. However, the new work points to changes in blood sugar control.

The difference between the fasting blood glucose level and the A1c level is generally smaller than the difference in insulin sensitivity. But A1c and fasting blood glucose may underestimate the potential effects of statins, as doctors may increase diabetes therapy in response to these changes.

Insulin sensitivity is also rarely measured in the real world. Author Dr Ishak Mansi, said in an interview that “This study translates the findings reported in academic studies on the increase in insulin resistance associated with statin use in the literature. research data into the language of everyday patient care. This means: patients on statin therapy may need increased therapy in their diabetes and may have a higher incidence of uncontrolled diabetes.”

The study was published online in the journal JAMA Internal Medicine.

Mansi, an intern at VA Health System North Texas and Professor of Medicine, Data, and Population Science at the University of Texas, both in Dallas, cautions against over-interpreting the findings. “This is an observational study; so it can establish the association, but not the cause.”

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There is no reason to refuse Statin

Mansi notes that it is important to distinguish between people who are prescribed statins as a primary prevention measure against cardiovascular disease, and those who start taking statins with pre-existing heart disease for secondary prevention. broadcast. Statins are believed to be the primary type of therapy for secondary prevention. “Their benefits are enormous, and based on our research, we emphasize that no patient should stop taking a statin, they should instead talk to their doctor,” says Mansi.

Om Ganda, who was asked for comment, said that the study was one of the few that looked at statin use and progression of real patients with diabetes, and is one The first has a design that fits the trend. As a result, it is impossible to prevent doctors from prescribing and preventing patients from accepting statins. Ganda, Medical Director of the Lipid Clinic at Joslin Diabetes Center and an Associate Professor of Medicine at Harvard Medical School, both in Boston, says, “Statins should not be discontinued in people at risk. higher risk of cardiovascular disease, even for primary prevention, because the risk of progression of glucose levels is relatively smaller and controllable, rather than inducing cardiovascular risks by how to discontinue or not initiate treatment when indicated by current guidelines”.

According to Gandastatin, statins may increase the risk of progression of diabetes by promoting insulin resistance, and they may also decrease beta cell function, which in turn may decrease insulin secretion.

A study group consisted of 83,022 pairs of statin users and matched controls, of which 95% were men; 68.2% are white; 22% are black; 2.1% are Native American, Pacific Islander or Alaska Native; and 0.8% Asian. The average age is 60 years old.

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Approximately 56% of statin users progressed to diabetes, compared with 48% of control patients (odds ratio 1.37; P<.001). This progression is defined as increased management of diabetes through the use of new-generation insulin or increased number of classes of drugs, new-onset chronic hyperglycemia, or acute complications of hyperglycemia. blood.

Associations were seen in component measures, including increased number of hypoglycemic measures (OR, 1.41; P<.001), frequency of new-generation insulin use (OR, 1.16; P<. 001), persistent blood glucose (OR, 1.13; P<.001) and a new diagnosis of ketoacidosis or uncontrolled diabetes (OR, 1.24; P<.001).

There is also a dose-response relationship between the intensity of LDL cholesterol-lowering drugs and diabetes progression.

More research is needed

The findings don’t necessarily have a strong clinical impact, but the researchers hope it will advance the personalization of statin treatment. The benefits of statins have been well studied, but their potential harms have gone unnoticed. Mansi hopes to learn more about which populations may gain the most benefit for primary cardiovascular disease prevention, such as the elderly versus younger populations, the healthy or the elderly. disease, and in people with well-controlled and poorly controlled diabetes. “Answering these questions (will) impact hundreds of millions of patients and cannot be delayed,” Mansi said. He also called for funding specifically to study the side effects of commonly used drugs.


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Translated by: Thuy Linh

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