A massive percentage of people with diabetes, both type 1 and type 2, areadvised to take statins. These cholesterol-lowering drugs are associated with very significant health benefits, particularly a lower risk of early death from cardiovascular disease.
But did you know that statins — the widely-prescribed cholesterol drugs — can cause blood sugar spikes? For some people, they may even trigger the development of type 2 diabetes, a condition sometimes called statin-induced diabetes.
This article will discuss the risk of statin-induced hyperglycemia and diabetes — and why health authorities believe that the benefits of statins still outweigh the risks.
The Benefits of Statins
If you have diabetes, you’re probablysupposed to be taking a statin, too. Diabetes authorities recommend that a very high percentage of people with diabetes, whether type 1 or type 2, should be on statin therapy, including everyone over the age of 40. (An online risk calculator can show you your own recommendations.)
Statins are primarily intended to lower LDL cholesterol, the so-called “bad cholesterol” that is believed to clog our arteries and lead to heart attack and stroke. But many large and rigorous trials have found that statins have additional benefits that can’t be explained by improvements in LDL levels, and that the drugs even confer major benefits to people who do not have elevated LDL to start with.
TheCARDS trial, for example, was terminated two years ahead of time because the statin intervention was found to be so effective. Adults with type 2 diabetes using a statin were 27 percent less likely to die during the course of the trial, and 37 percent less likely to experience a major cardiovascular event. The JUPITER trial evaluated statins in patients with inflammation but normal LDL cholesterol. This trial was also stopped early because it was so effective: Participants taking a statin were 20 percent less likely to die, and 44 percent less likely to have any vascular event.
Though medical authorities almost universally endorse the use of statins, there is good evidence that these drugs can have an unexpected negative metabolic effect: they provoke insulin resistance and higher blood sugar. And it pushes some people over the edge 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 people with diabetes: Statins are known toincrease insulin resistance, leading to higher blood sugar levels.
For over a decade, the Food and Drug Administrationhas required a warning on statin labels stating that the drugs “may raise levels of blood sugar.” Multiple other studies in 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 a higher likelihood of insulin treatment initiation, developing significant hyperglycemia, experiencing acute glycemic complications, and being prescribed an increased number of glucose-lowering medication classes.”
If you already have diabetes of any type, statins can make your glucose management more challenging. Many studies, such as a2018 meta-analysis, have pointed to increased A1C and fasting blood glucose levels, and theDiabetes Daily forums have many reports of people experiencing this side effect. A2021 review which considered multiple meta-analyses concluded that “there is a small aggregate effect of statins in increasing hemoglobin A1C. This effect may be greatest with high-dose atorvastatin and least with pitavastatin.”
One thing is clear: Despite some skepticism within the diabetes community, medical authorities are unanimous that the positive health effects of statins outweigh the risks for people with diabetes.
That doesn’t mean that you need to accept statin-induced hyperglycemia as a necessary evil. Aclinical guideline from the Southern Medical Journal suggests that people with diabetes who are just 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 prevent hyperglycemia from worsening.
When statins raise blood sugar levels, they will invariably help push some people with prediabetes over the line into overt type 2 diabetes:
Ananalysis of the JUPITER trial, mentioned above as one of the strongest experiments showing the benefits of statins, also found that trial participants were much more likely to be diagnosed with type 2 diabetes. A diabetes prevention study that evaluated adults at a “high risk” of diabetes found that those who developed type 2 diabetes within a decade were 36 percent more likely to have been prescribed a statin — an association that was not “confounded” by factors like high cholesterol levels.
The risk of statin-induced diabetes is greater with high-intensity statin therapy and larger statin doses. Traditional diabetes risk factors, such as obesity, genetic history, and sedentary lifestyle, also help make statin-induced diabetes more likely. The risk is especially high with the concurrent use ofglucocorticoid steroids, which also increase insulin resistance. Atorvastatin (Lipitor) may have a stronger glucose-raising affect than other statins. Pitavastatin (Livalo, Zypitamag) may have a lower risk of increased insulin resistance, though it is also less strongly associated with positive cardiovascular effects.
Very few people are told that they have a specific condition called “statin-induced diabetes” — the condition is treated as if it were identical to other common cases of type 2 diabetes.
In aneditorial, Eliot Brinton, MD, considers the clinical implications for people that appear to have cases of statin-induced diabetes. Like other experts, he suggests that “the overall risk-benefit ratio remains strongly in favor of statin therapy,” meaning that hyperglycemia is not alone sufficient reason to stop using statins. But he further argues that we should not simply accept the increased risk of new-onset type 2 diabetes. Instead, clinicians should consider some of the following additional measures to help keep hyperglycemia under control:
Diet and lifestyle changes to combat rising blood sugar levels The use of other glucose-lowering medicines A preference for statins that are less likely to trigger insulin resistance, especially pitavastatin Taking a “less is more” approach and not immediately choosing high-intensity or maximally-tolerated statin regimens
The Bottom Line
Statins are almost universally recommended to adults with diabetes because they promise incredible protection from cardiovascular disease. But at the same time, these drugs have a concerning tendency to raise blood sugar levels. In some people, statins can even trigger new cases of type 2 diabetes.
Experts agree that the benefits of statins far outweigh the risks, and that if statins cause a modest increase in your A1C, it’s still worth it for the impressive cardiovascular protection. But that doesn’t mean that you should just accept higher blood sugar levels. If you’re concerned that statins are frustrating your blood sugar management, you can talk to your doctor about switching to a different statin, moderating your dosage, or employing other techniques — including lifestyle changes or extra medication — to help keep your glucose numbers in check.
Colhoun H et al. Primary Prevention of Cardiovascular Disease With Atorvastatin in Type 2 Diabetes in the Collaborative Atorvastatin Diabetes Study (Cards): Multicentre Randomised Placebo-Controlled Trial. Lancet. August 2004.
FDA Adds Diabetes, Memory Loss Warnings to Statins. Reuters. February 29, 2012.
Duvnjak L and Blaslov K. Statin Treatment Is Associated With Insulin Sensitivity Decrease in Type 1 Diabetes Mellitus: A Prospective, Observational 56-Month Follow-Up Study. Journal of Clinical Lipidology. July-August 2016.
Mansi I et al. Association of Statin Therapy Initiation With Diabetes Progression: A Retrospective Matched-Cohort Study. JAMA Internal Medicine. October 4, 2021.