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22 December 2015

What Your Doctor May Not Tell You About the Statin and Diabetes Connection

Pharmaceutical companies earn billions of dollars from the sale of statins:  one reason for your doctor not telling you about the statin-diabetes connection.  See this extract from the People's Pharmacy ("Billion Dollar Drugs are Dramatically Disappointing" (21 December 2015):  

In its Statistical Brief #458 (November 2014) AHRQ reports on Trends in Statin Therapy among Adults (Age ≥ 18), United States, 2000 to 2011:

“The number of adults (age ≥ 18) who reported using prescribed statins increased from an average 17.6 million annually in 2000-2001 to 40.8 million in 2010-2011.”

The number of statin prescriptions filled by adults (age ≥ 18) increased from an average 102.2 million annually in 2000-2001 to 237.9 million in 2010-2011.

Among adults (age ≥ 18), annual total expenditures (in constant 2011 dollars) for all statins rose, on average, from $11.5 billion in 2000-2001 to $21.6 billion in 2010-2011.” 

What Your Doctor May Not Tell You About the Statin and Diabetes Connection
The People's Pharmacy, 16 November 2015

It came as a shock to many cardiologists to learn statins could raise blood sugar or cause diabetes. Many still don't warn patients about this side effect.

Q. What is the relationship between long-term statin use (specifically atorvastatin) and adult-onset type 2 diabetes? Lipitor was prescribed for me in 1998 and has successfully lowered my cholesterol.

In the past year my blood sugar went up substantially, and I’ve experienced preliminary symptoms of diabetes. I have no risk factors: my weight is normal and I walk at least two miles a day with additional daily weight-bearing exercise. I have no family history of diabetes.

My diet is primarily Mediterranean because I’m married to a Sicilian. It’s a little high in carbs but low in red meat and high in seafood and plant proteins.

I’ve stopped taking the statin. Will my metabolism return to normal?

The Statin and Diabetes Connection

A. In 2003 we started getting questions from readers about elevated blood sugar as a side effect of Lipitor. One of the first questions was the following (published in our syndicated newspaper column on 1/20/2003):

“Recently, our physician prescribed Lipitor for my husband and myself. We both have been diagnosed with type 2 diabetes. We both take Glyburide and my husband takes Avandia as well.

“Since we started on Lipitor, our blood sugar has been rising rapidly. My husband asked the doctor about changing to Tricor, but he was told it would not help him much and he should stay with Lipitor. It seems that Lipitor is affecting our blood sugar. Is this possible?”

We contacted University of California, San Diego, statin researcher Beatrice Golomb, MD, PhD. Dr. Golomb responded:

“There are two studies that have shown unexpected significant increases in blood sugar or in hemoglobin A1C (which is an index of blood sugar over time) with statin use. Though increases are modest on average, some people appear to experience more considerable increases.”

We encouraged this reader and her husband to let the doctor know there was a statin and diabetes connection; that atorvastatin, as well as other statin-type cholesterol-lowering drugs (lovastatin, pravastatin, simvastatin, etc.) could increase blood sugar. We also invited readers to share their stories with us.

We began hearing from others who either developed diabetes after taking a statin or had more difficulty controlling blood sugar once a statin was on board. Most physicians were unaware that this was a possibility.

Some got really angry that we had written about a statin and diabetes connection. They felt that we were planting a seed of doubt about the benefits of statins with no proof that drugs like atorvastatin or simvastatin raised blood glucose levels.

The JUPITOR Proof:

It wasn’t until the JUPITER (Justification for the Use of Statins in Primary Prevention: AnIntervention Trial Evaluating Rosuvastatin trial) study was published in 2008 that a clear connection was established between statins and diabetes (New England Journal of Medicine, Nov. 20, 2008). Even though the authors did not mention this complication in their enthusiastic support for Crestor (rosuvastatin) in the conclusion section of the paper, they did describe the statin and diabetes connection in the results and discussion section.

This was the first real proof that statins raised blood sugar levels in some patients. Even after this study was published in a reputable journal, many statin enthusiasts were reluctant to accept the finding. They insisted it was coincidental. For those that did accept the data, many were quick to insist that even if statins did trigger diabetes or raise blood sugar, the benefits of the drugs far outweighed the risks of diabetes.

More Evidence:

Since then, other studies have reinforced the statin-diabetes connection. An article in Diabetologia (May, 2015) confirmed this risk:

Finnish men taking a statin were 46 percent more likely to be diagnosed later with type 2 diabetes than those not on such a cholesterol-lowering drug.

Statin Takers Figured This Out Long Ago:

January 12, 2009:

Q. I was put on Lipitor to control cholesterol and found it shot my blood sugar through the roof. My doctor suggested switching to Crestor. Would this drug also affect blood sugar?

A. You are not the first person to note that some cholesterol-lowering medicines might raise blood sugar levels. Another reader reported that after taking Crestor, his type 2 diabetes numbers also “went through the roof.” In addition, he reported: “my hands, feet and arms tingled so much I could hardly stand it.”

February 15, 2010:

“I have been taking Crestor. It lowered my cholesterol very well, but my blood sugar went out of control. My HbA1c went from 6.8 to 7.3 in just a short while, and my morning blood glucose numbers went from 110 – 130 to 161 – 217.

“I stopped taking Crestor a few days ago and my numbers are already starting to drop. This morning the reading was 144 and my mid-morning blood sugar was only 96 instead of in the low 200s.”
The Bottom Line:

Cardiologists who downplay the importance of the statin and diabetes connection confound us. People who have elevated blood sugar levels are at greater risk of heart attacks and strokes, the very things statins are supposed to prevent. Why would you want to increase the risk of developing diabetes or making it worse with a medication?

With your healthy lifestyle, you may be able to reverse this trend. At this time there is not a lot of research on how long it takes, but we have heard from people like the reader above that blood glucose can move back towards the normal range. Cut back on carbs and keep up the exercise.

You’ll learn more about controlling cholesterol and blood sugar with and without drugs inBest Choices From The People’s Pharmacy (available at PeoplesPharmacy.com).


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