A number of studies have shown that statins increase the risk of diabetes (PMID 27277934, 24623264, 27616593). Although some, more recent studies including more data have suggested that such earlier studies might have been mistaken (PMID 34261627), and although some statins actually reduce the risk of diabetes (pitavastatin; PMID 34261627), this podcast explores the question: what if statins *do* increase the risk of being diagnosed with diabetes?

Again we are confronted with a recurring theme on this podcast: although statins may increase fasting blood glucose and increase the risk of being diagnosed with diabetes according to one blood marker (glucose), this does not necessarily mean that statins are harmful. This is because glucose is only one marker of health and other markers might be more important for health. In other words, one cannot infer from one plausible mechanism (elevated glucose) that disease is more probable without actual health outcome evidence.

The major chronic complications of type 2 diabetes–indeed, the major reasons we are concerned about the development of type 2 diabetes–is cardiovascular disease and microvascular disease. People with type 2 diabetes are at 2-3 times higher risk of cardiovascular disease. One of the principal risk factors for cardiovascular disease is elevated blood lipids. This is why people with diabetes are often aggressively treated with statins according to official treatment guidelines: while the statins might modestly increase blood glucose, they help to reduce the major complications of that elevated blood glucose far more effectively than the small rise increases it. Although statins may increase the risk of diabetes, they are so effective at treating cardiovascular disease by lowering lipids that they are used in people with diabetes despite this fact.

There is also no evidence that statins increase the rate of microvascular disease associated with diabetes; in fact, they may reduce it.

There may be some reason to reduce dosage, change medication, or start combination therapy with a lower dose of statin if there are excessive increases in blood glucose. If one is at elevated risk of cardiovascular disease, statins are an excellent option. Talk to your doctor before considering switching or discontinuing medications.

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