Available online 15 February 2023, 101749

Randomised trials suggest moderate intensity statins increase type 2 diabetes risk by around 11% with a potential further 12% moving to high intensity statins, such that high intensity may increase risk by 20% or more relative to placebo. These data translate into one extra diabetes case per 100-200 statin recipients over 5 years, with ~10-fold greater benefits on major vascular outcomes. The underlying mechanisms for diabetes harm are not clear but could include modest weight gain (noted in randomised trials), or, speculatively, beta cell harm. Concordant genetic studies link HMG CoA Reductase inhibition to diabetes risk and weight gain. Patients should be warned about a slight diabetes risk when prescribed statin and told that modest lifestyle improvements can i) nullify diabetes risk, and ii) improve cardiovascular risks beyond statins. Doctors should also measure glycaemia status post statin commencement, most commonly with HbA1c, and tailor lifestyle advice and care dependent on the results.

Randomised trials

Mendelian randomisation

HbA1c

lifestyle

cardiovascular outcomes

© 2023 The Author(s). Published by Elsevier Ltd.