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Although most statin trials to date had not found a relationship between statin use and diabetes incidence, the recent JUPITER (Crestor 20mg Versus Placebo in Prevention of Cardiovascular (CV) Events) trial that reported an increased risk for diabetes in patients assigned to the rosuvastatin arm seconded concerns raised several years ago when the PROSPER (PROspective Study of Pravastatin in the Elderly at Risk) trial reported similar findings with pravastatin. However, most trials had not looked at diabetes as a secondary outcome. The investigators of the current study are to be commended for obtaining access to previously unpublished results, thus eliminating a common flaw in meta-analyses.
With these data, they were able to identify a small but significantly increased risk for incident diabetes associated with statin use. Like observational studies, however, a meta-analysis cannot establish causation; therefore, it is possible that unmeasured factors explain the results. For example, the analysis did not account for baseline glycemic level. This is unlikely to be different between groups in randomized trials, but it is possible or even likely that patients who developed diabetes were more dysglycemic, and that a small "nudge" from statins was enough for them to convert to diabetes. If so, these patients were already at increased cardiovascular risk, in which case treatment with statins would be far more important than the few milligrams per deciliter of fasting glucose that took these patients over the diagnostic threshold for diabetes. It is also important to note that these results do not address whether statins raise blood sugar in people already diagnosed with diabetes, most of whom should already be taking statins.
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