Statin-induced New-onset Diabetes

• Although a number of questions remain unanswered, the available evidence supports that statins do increase the chances of type 2 diabetes mellitus (T2DM) with some statins being more strongly related (e.g., simvastatin, rosuvastatin and atorvastatin) than others (e.g., pravastatin).

• Overall, the risk of incident diabetes mellitus with statin therapy is present but largely due to high or very high CVD risk, despite the risk of T2DM development until they achieve the target LDL-C levels.

• Before initiation of statin therapy, the risk of diabetes should be assessed.

• Statin-treated patients at high risk of developing diabetes should be monitored for changes in blood glucose and HbA1c levels, and preventive lifestyle modification should be introduced.

• Several mechanisms through which statin treatment causes beta-cell dysfunction and insulin resistance in peripheral tissues have been identified.

• New data from Abbasi et al shows that (2022) increased insulin resistance can now be considered likely the primary means by which statins cause new-T2DM.

• Pitavastatin also had a significantly lower risk of new-onset T2DM than each atorvastatin or rosuvastatin in the sub-analysis.

• Two uncommonly used statins, pravastatin or especially pitavastatin may be favored over other statins in patients at elevated risk of NOD2, due to their apparently lower tendency to cause diabetes.

• The diabetogenic effects are related both to the dose and statin class.

• The overall risk-benefit ratio remains strongly in favor of statin therapy as firstline ASCVD prevention, even in patients who later develop NOD2 because of that treatment.

• The current data do not support discontinuing statins if someone has diabetes mellitus or if newly diagnosed with diabetes mellitus.