Medically reviewed by Anna Goldman, MD.
An enormous percentage of individuals with diabetes, each type 1 and sort 2, are advised to take statins. These cholesterol-lowering drugs are related to very significant health advantages, particularly a lower risk of early death from heart problems.
But did you recognize that statins — the widely-prescribed cholesterol drugs — could cause blood sugar spikes? For some people, they might even trigger the event of type 2 diabetes, a condition sometimes called statin-induced diabetes.
This text will discuss the danger of statin-induced hyperglycemia and diabetes — and why health authorities imagine that the advantages of statins still outweigh the risks.
The Advantages of Statins
If you’ve got diabetes, you’re probably imagined to be taking a statin, too. Diabetes authorities recommend that a really high percentage of individuals with diabetes, whether type 1 or type 2, needs to be on statin therapy, including everyone over the age of 40. (An online risk calculator can show you your individual recommendations.)
Statins are primarily intended to lower LDL cholesterol, the so-called “bad cholesterol” that’s believed to clog our arteries and result in heart attack and stroke. But many large and rigorous trials have found that statins have additional advantages that may’t be explained by improvements in LDL levels, and that the drugs even confer major advantages to individuals who don’t have elevated LDL to begin with.
The CARDS trial, for instance, was terminated two years ahead of time since the statin intervention was found to be so effective. Adults with type 2 diabetes using a statin were 27 percent less prone to die throughout the course of the trial, and 37 percent less prone to experience a serious cardiovascular event. The JUPITER trial evaluated statins in patients with inflammation but normal LDL cholesterol. This trial was also stopped early since it was so effective: Participants taking a statin were 20 percent less prone to die, and 44 percent less prone to have any vascular event.
Though medical authorities almost universally endorse the usage of statins, there may be good evidence that these drugs can have an unexpected negative metabolic effect: they provoke insulin resistance and better blood sugar. And it pushes some people over the sting from prediabetes to full-blown type 2 diabetes.
Statins, Insulin Resistance, and High Blood Sugar
Despite the impressive evidence in favor of statin use, there’s one big red flag for individuals with diabetes: Statins are known to increase insulin resistance, resulting in higher blood sugar levels.
For over a decade, the Food and Drug Administration has required a warning on statin labels stating that the drugs “may raise levels of blood sugar.” Multiple other studies within the years since have found similar effects:
- A 2016 study of patients with type 1 diabetes found that statin use “deteriorates insulin sensitivity.”
- A 2021 investigation found that “statin users had the next likelihood of insulin treatment initiation, developing significant hyperglycemia, experiencing acute glycemic complications, and being prescribed an increased variety of glucose-lowering medication classes.”
Should you have already got diabetes of any type, statins could make your glucose management more difficult. Many studies, corresponding to a 2018 meta-analysis, have pointed to increased A1C and fasting blood glucose levels, and the Diabetes Day by day forums have many reports of individuals experiencing this side effect. A 2021 review which considered multiple meta-analyses concluded that “there may be a small aggregate effect of statins in increasing hemoglobin A1C. This effect could also be biggest with high-dose atorvastatin and least with pitavastatin.”
One thing is evident: Despite some skepticism throughout the diabetes community, medical authorities are unanimous that the positive health effects of statins outweigh the risks for individuals with diabetes.
That doesn’t mean that it’s essential to accept statin-induced hyperglycemia as a mandatory evil. A clinical guideline from the Southern Medical Journal suggests that individuals with diabetes who are only starting moderate- or high-intensity statin therapy should pay close attention to their blood sugar levels and be prepared to make other changes to their lifestyle or medication to forestall hyperglycemia from worsening.
Statin-Induced Diabetes
When statins raise blood sugar levels, they’ll invariably help push some individuals with prediabetes over the road into overt type 2 diabetes:
- An evaluation of the JUPITER trial, mentioned above as one among the strongest experiments showing the advantages of statins, also found that trial participants were rather more prone to be diagnosed with type 2 diabetes.
- A diabetes prevention study that evaluated adults at a “high risk” of diabetes found that those that developed type 2 diabetes inside a decade were 36 percent more prone to have been prescribed a statin — an association that was not “confounded” by aspects like high levels of cholesterol.
It’s a surprising relationship, on condition that statins are otherwise good in your metabolism. A recent review within the Cleveland Clinic Journal of Medicine summarizes some extra details:
- The danger of statin-induced diabetes is larger with high-intensity statin therapy and bigger statin doses.
- Traditional diabetes risk aspects, corresponding to obesity, genetic history, and sedentary lifestyle, also help make statin-induced diabetes more likely.
- The danger is very high with the concurrent use of glucocorticoid steroids, which also increase insulin resistance.
- Atorvastatin (Lipitor) could have a stronger glucose-raising affect than other statins.
- Pitavastatin (Livalo, Zypitamag) could have a lower risk of increased insulin resistance, though additionally it is less strongly related to positive cardiovascular effects.
Only a few persons are told that they’ve a particular condition called “statin-induced diabetes” — the condition is treated as if it were equivalent to other common cases of type 2 diabetes.
In an editorial, Eliot Brinton, MD, considers the clinical implications for folks that appear to have cases of statin-induced diabetes. Like other experts, he suggests that “the general risk-benefit ratio stays strongly in favor of statin therapy,” meaning that hyperglycemia isn’t alone sufficient reason to stop using statins. But he further argues that we must always not simply accept the increased risk of new-onset type 2 diabetes. As an alternative, clinicians should consider a number of the following additional measures to assist keep hyperglycemia under control:
- Eating regimen and lifestyle changes to combat rising blood sugar levels
- The usage of other glucose-lowering medicines
- A preference for statins which are less prone to trigger insulin resistance, especially pitavastatin
- Taking a “less is more” approach and never immediately selecting high-intensity or maximally-tolerated statin regimens
The Bottom Line
Statins are almost universally advisable to adults with diabetes because they promise incredible protection from heart problems. But at the identical time, these drugs have a concerning tendency to lift blood sugar levels. In some people, statins may even trigger latest cases of type 2 diabetes.
Experts agree that the advantages of statins far outweigh the risks, and that if statins cause a modest increase in your A1C, it’s still value it for the impressive cardiovascular protection. But that doesn’t mean that it’s best to just accept higher blood sugar levels. Should you’re concerned that statins are frustrating your blood sugar management, you’ll be able to talk over with your doctor about switching to a unique statin, moderating your dosage, or employing other techniques — including lifestyle changes or extra medication — to assist keep your glucose numbers in check.