A dysglycaemic effect of statins in diabetes: relevance to clinical practice?

In this issue of the journal, Erqou and colleagues (DOI 10.​1007/​s00125-014-3374-x) report, in a systematic review and meta-analysis of randomised trials, a very modest (1.3 mmol/mol or 0.12%) albeit significant increase in HbA_1c in patients with diabetes treated with statins, compared with control. Here, we discuss the clinical relevance of the findings. Given the overwhelming benefit of statins on cardiovascular outcomes in diabetes, current guidelines recommending statins for primary prevention in type 2 diabetes should not change, and any effect on microvascular risk is likely to be minimal. Of course, all patients recommended for statin treatment, whether they have diabetes or not, should now be warned of a slight potential for dysglycaemia on starting statins, but at the same time they should be told that very modest lifestyle improvement will help offset this dysglycaemia risk. Finally, we remind colleagues that nearly all drugs have side effects and we should not be surprised by this statin–dysglycaemia effect, which can be easily managed.