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Statins worsen glycemic control of T2DM in target LDL-c level and LDL-c reduction dependent manners: a meta-analysis

Rongrong Cai1,2, Yang Yuan1, Jie Sun1

  • 1a Department of Endocrinology , The Affiliated ZhongDa Hospital of Southeast University , Nanjing , PR China.

Expert Opinion on Pharmacotherapy
|August 5, 2016
PubMed
Abstract

Insights

Statin therapy negatively impacts glycemic control in type 2 diabetes mellitus (T2DM). Intensive low-density lipoprotein cholesterol (LDL-c) lowering strategies worsen glycosylated hemoglobin (HbA1c) levels, particularly with lower LDL-c targets and higher LDL-c reduction.

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Disorders

Background:

  • Recent studies link low-density lipoprotein cholesterol (LDL-c) reduction and statin therapy to increased diabetes incidence.
  • Understanding statin's influence on glycemic control in type 2 diabetes mellitus (T2DM) is crucial for patient management.

Purpose of the Study:

  • To investigate the impact of statin therapy on glycemic control in patients with T2DM.
  • To analyze how varying LDL-c targets and reduction levels affect glycemic parameters.

Main Methods:

  • A systematic search of Medline, Embase, and Cochrane Central for randomized controlled trials in T2DM patients.
  • Analysis of trials with LDL-c targets ≤2.6 mmol/L or LDL-c reduction ≥30%.
  • Meta-analysis to calculate mean differences in glycosylated hemoglobin (HbA1c) and fasting blood glucose based on LDL-c levels, reduction, and statin dose.

Main Results:

  • Meta-analysis of 6,875 participants (3,619 statin, 3,256 control) revealed statin therapy significantly impacts HbA1c.
  • Intensive LDL-c lowering statin therapy showed a more pronounced detrimental effect on HbA1c (SMD 0.10%) compared to all statin trials (SMD 0.07%).
  • Glycemic control worsening intensified with decreased target LDL-c levels and increased LDL-c reduction; low baseline and endpoint LDL-c were risk factors.

Conclusions:

  • Statin therapy adversely affects glycemic control in T2DM patients.
  • The negative impact on glycemic control is dependent on the target LDL-c level and the extent of LDL-c reduction achieved.
  • Lowering LDL-c to very low levels with statins requires careful consideration of glycemic effects in T2DM.
Keywords:
DiabetesHbA1cLDL-cmeta-analysisstatins

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