Published: 2019-05-24

Effect of statins treatment on glycemic status and development of new onset diabetes mellitus in a tertiary care teaching hospital: a cross sectional study

K. N. S. V. Chalapathi Rao, Ashok Vankayala, Suresh Babu Sayana, D. S. S. K. Raju


Background: Several observational studies, well controlled randomized trials and meta-analyses reported that patients treated with statins has high risk of new onset diabetes mellitus (NODM), but the exact incidence and mechanism is still unclear and controversy. The present study was planned to find out the incidence of prediabetes and NODM and possible mechanism of action.

Methods: This was a prospective, cross‑sectional study carried out at the Department of General Medicine for a period of one and half year between August 2017 and February 2019. Normoglycemic patients whose fasting blood glucose levels below 100 mg/dL and at least one year of treatment with statins were recruited in the study. Glycaemic status, development of prediabetes and NODM and insulin resistance were the primary outcomes whereas lipid profile, adverse drug effects of statins were secondary outcomes. Collected data was analysed by suitable statistical methods.

Results: A total of 146 patients were recruited and 120 completed the entire study. Mean fasting blood glucose levels before initiation of statin therapy was 89.45±10.21. After one year of statin therapy, patients were separated as prediabetics and new onset diabetics and there mean fasting blood glucose levels were 116.24±12.86 (n=10) and 152.44±20.12 (n=12) respectively. A total of 12 (10.0%) patients were developed NODM and 10 (8.2%) patients developed prediabetes at the end of statin therapy. Atorvastatin 40mg was most frequency prescribed statin followed by Atorvastatin 20mg. A total of 70 (58.3%) study participants developed mild to moderate drug related adverse effects (ADRs), statin‑induced myalgia (55.7%) was the most common ADR.

Conclusions: Patients treatment with statins had developed prediabetes and NODM. Atorvastatin 40mg and greater dose significantly induced NODM. Fasting blood glucose levels should be measured periodically with prescription contains higher doses of statins.


Atorvastatin, Diabetes, Hyperglycaemia, HMG-CoA inhibitors, New onset diabetes, Prediabetes, Statins

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Nethan S, Sinha D, Mehrotra R. Non communicable disease risk factors and their trends in India. APJCP. 2017;18(7):2005.

WHO | Global Action Plan for the Prevention and Control of NCDs 2013-2020. Accessed at: on: WHO. cited 2019: 2.

Stancu C, Sima A. Statins: mechanism of action and effects. J Cellular Molecular Med. 2001;5(4):378-87.

Choudhry NK, Dugani S, Shrank WH, Polinski JM, Stark CE, Gupta R, Prabhakaran D, et al. Despite increased use and sales of statins in India, per capita prescription rates remain far below high-income countries. Health Affairs. 2014;33(2):273-82.

Gupta R, Rao RS, Misra A, Sharma SK. Recent trends in epidemiology of dyslipidemias in India. Indian Heart J. 2017;69(3):382-92.

Nelson RH. Hyperlipidemia as a risk factor for cardiovascular disease. Primary Care: Clinics Office Pract. 2013;40(1):195-211.

Gyárfás I, Keltai M, Salim Y. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries in a case-control study based on the inter heart study. Orvosi Hetilap. 2006;147(15):675-86.

Currie O, Mangin D, Williman J, McKinnon-Gee B, Bridgford P. The comparative risk of new-onset diabetes after prescription of drugs for cardiovascular risk prevention in primary care: a national cohort study. BMJ Open. 2013;3(11):e003475.

Gayoso-Diz P, Otero-González A, Rodriguez-Alvarez MX, Gude F, García F, et al. Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: epirce cross-sectional study. BMC End Dis. 2013;13(1):47.

Chen H, Sullivan G, Quon MJ. Assessing the predictive accuracy of QUICKI as a surrogate index for insulin sensitivity using a calibration model. Diab. 2005;54(7):1914-25.

Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metabol. 2000;85(7):2402-10.

Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360(9346):1623-30.

Preiss D, Seshasai SR, Welsh P, Murphy SA, Ho JE, Waters DD, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA. 2011;305(24):2556-64.

Navarese EP, Buffon A, Andreotti F, Kozinski M, Welton N, Fabiszak T, et al. Meta-analysis of impact of different types and doses of statins on new-onset diabetes mellitus. Am J Cardiol. 2013;111(8):1123-30.

Esteghamati A, Ashraf H, Khalilzadeh O, Zandieh A, Nakhjavani M, Rashidi A, et al. Optimal cut-off of homeostasis model assessment of insulin resistance (HOMA-IR) for the diagnosis of metabolic syndrome: third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007). Nutrit metabol. 2010;7(1):26.

Muniyappa R, Lee S, Chen H, Quon MJ. Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metabol. 2008;294(1):E15-26.

Ahmadizar F, OchoaRosales C, Glisic M, Franco OH, Muka T, Stricker BH. Associations of statin use with glycaemic traits and incident type 2 diabetes. British J Clin Pharm. 2019.

De JL, Mihos CG, Horvath SA, Santana O. The Pleiotropic Effects of Statins in Endocrine Disorders. Endocrine Metabolic Immune Dis Drug Targets. 2019.

Khan SU, Rahman H, Okunrintemi V, Riaz H, Khan MS, Sattur S, et al. Association of lowering low‐density lipoprotein cholesterol with contemporary lipid‐lowering therapies and risk of Diabetes Mellitus: A Systematic Review and meta‐analysis. J Am Heart Assoc. 2019;8(7):e011581.

Freeman DJ, Norrie J, Sattar N, Neely RD, Cobbe SM, Ford I, et al. Pravastatin and the development of diabetes mellitus: evidence for a protective treatment effect in the west of Scotland coronary prevention study. Circulation. 2001;103(3):357-62.

Mora S, Ridker PM. Justification for the use of statins in primary prevention: an intervention trial evaluating rosuvastatin (JUPITER)-can C-reactive protein be used to target statin therapy in primary prevention?. Am J Cardiol. 2006;97(2):33-41.

Sattar N, Preiss D, Murray HM, Welsh P, Buckley BM, de Craen AJ, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010;375(9716):735-42.

Thomson SR, Chogtu B, Shetty R, Devasia T. Analysis of glycaemic status in diabetes-naïve patients on statins: A hospital-based cross-sectional study. Indian J Pharma. 2018;50(6):320.

Koh KK, Quon MJ, Han SH, Lee Y, Kim SJ, Shin EK. Atorvastatin causes insulin resistance and increases ambient glycemia in hypercholesterolemic patients. J Am Coll Cardiol. 2010;55(12):1209-16.

Sever PS, Dahlöf B, Poulter NR, Wedel H, Beevers G, Caulfield M, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian cardiac outcomes trial- Lipid lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet. 2003;361(9364):1149-58.

Keech A, Colquhoun D, Best J, Kirby A, Simes RJ, Hunt D, et al. Secondary prevention of cardiovascular events with long-term pravastatin in patients with diabetes or impaired fasting glucose: results from the LIPID trial. Diab Care. 2003;26(10):2713-21.

Thomson SR, Chogtu B, Shetty R, Devasia T. Analysis of glycaemic status in diabetes-naïve patients on statins: A hospital-based cross-sectional study. Indian J Pharm. 2018;50(6):320.

SS. Drug utilization evaluation of HMG-COA reductase inhibitors in a tertiary care teaching hospital. Indian J Pharm Pract. 2017;10(4):251-9.

Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, 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. 2004;364(9435):685-96.