Total Pageviews

Thursday 22 October 2015

Statins are Independently Associated with Increased HbA1c in Type 1 Diabetes

Highlights

•Statin use has been associated with increased risk of developing type 2 diabetes (T2DM), and with impaired glycemic control in T2DM patients. The association between statin use and glycemic control in type 1 diabetes (T1DM) is unknown.
•In the present study of patients with T1DM, use of statins is independently associated with impaired glycemic control.
•These results are the first in patients with T1DM, and may indicate a need to revisit dose of insulin when starting statin treatment.

Abstract


AIMS

Statin use has been associated with increased risk of developing type 2 diabetes (T2DM), and with impaired glycemic control in T2DM patients. The association between statin use and glycemic control in type 1 diabetes (T1DM) is unknown. The association between use of statins and glycemic control in T1DM patients without known heart disease was examined.

METHODS

Cross-sectional study of 1093 T1DM patients from the outpatient clinic at Steno Diabetes Center. Physical examination, questionnaires, and echocardiography were performed in all patients. Investigators were blinded to all laboratory measurements. Data were analyzed in uni-and multivariable models.

RESULTS


Mean age 49.6 years, 53% men, mean diabetes duration 25.5 years, 475 (43.5%) received statins. In baseline analyses statin users tended to be older, have longer diabetes duration, and have more severe kidney disease. Left ventricular ejection fraction was not associated with statin use. In multivariable models including age, gender, diabetes duration, BMI, blood pressure, physical activity, family history of cardiovascular disease, physical activity, albuminuria, eGFR, retinopathy, smoking, cholesterol, ejection fraction, triglycerides, and use of ACE/ATII-antagonists, aspirin, calcium-antagonists, betablockers or diuretics, statin use was independently and significantly associated with higher HbA1c (0.2% (95%CI: 0.1;0.4) (2.0 mmol/mol (0.2; 3.8)), p = 0.029).

CONCLUSIONS


In T1DM, use of statins is independently associated with impaired glycemic control. A causal relationship cannot be determined from this study. Given the benefit on cardiovascular outcome, this should not cause patients to stop statin treatment, but may indicate a need to revisit dose of insulin when starting statin treatment


Graham

6 comments:

Passthecream said...

" need to revisit dose of insulin when starting statin treatment. "
equals "how can we keep you alive just a little bit longer so you can buy some more of our lovely drugs."


Sheesh. Will the message ever seep through these rather thick medical skulls?


C.

Lisa said...

Rather than take statins, why not try a low carb diet and avoid margarine and vegetable oil ? Given that most patients "cholesterol levels " are just calculated from the Freidwald formula and lipoprotein particle size isn't actually measured, I would never take statins. From what I have researched, cardiovascular disease is really caused by glycation, oxidation and inflammation.

Lisa said...

So true! Many diabetics are automatically put on statins regardless of their blood glucose control.

Cheryl said...

I find issues like this really worrying. Some people are just happy to take medicinal drugs without question.
I personally will not take any drug if I can sort my problem via lifestyle, changes in diet etc.........

JanKnitz said...

" Given the benefit on cardiovascular outcome, this should not cause patients to stop statin treatment. . ."

And what benefits, exactly, are those???

chris c said...

The benefits exactly offset by the increase in insulin of course!

Hyperinsulinemia itself along with hyperglycemia is a major CVD risk factor. IMNSHO the changes in lipids are an indicator of the insulin level/insulin resistance. I DOUBLED my HDL and reduced my trigs to 1/10 of what they were. This is far from uncommon. I'm lucky that statins reduced my LDL without causing any of the side effects which are so common, but I'm left thinking "so what?"

Curiously when I went hypERthyroid it had exactly the same effect on my LDL as the statin, how weird is that? Not even the most clueless doctor would claim that hyperthyroid is good for you.