Effects of statin therapy on glycemic control and insulin resistance: A systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 36965747 · doi:10.1016/j.ejphar.2023.175672
What was done
A systematic review and meta-analysis of 67 randomized controlled trials involving more than 25,000 individuals evaluated the effect of statin therapy compared with placebo on glycemic parameters. Primary outcomes were changes in glycosylated hemoglobin (HbA1c) and homeostatic model assessment of insulin resistance (HOMA-IR). Subgroup analyses evaluated participants with altered baseline glycemic control (HbA1c ≥ 6.5% and HOMA-IR ≥ 2.15) versus normal glycemic control, as well as variations by statin type and dosage.
What was found
In individuals with altered glycemic control, statins significantly increased HbA1c (mean difference [MD] 0.21%, 95% CI 0.16 to 0.25) and HOMA-IR (MD 0.31, 95% CI 0.24 to 0.38). In individuals with normal glycemic control, statins increased HbA1c (MD 1.33%, 95% CI 1.31 to 1.35) and HOMA-IR (MD 0.49, 95% CI 0.41 to 0.58) relative to placebo. Statin type and dose did not significantly alter the magnitude of these effects.
Why it matters
This review provides quantitative synthesis showing that statin therapy directly worsens surrogate markers of insulin resistance and glycemic control regardless of drug choice, dosage, or baseline glycemic status.
Limits
The abstract does not report study-level heterogeneity, trial durations, risk of bias for included studies, or hard clinical endpoints such as incident type 2 diabetes diagnoses. The reported magnitude of HbA1c increase in normal-glycemic participants (MD 1.33%) is unusually large relative to clinical trial literature and cannot be independently audited from the abstract alone.
Cited by
- supports Statin medications increase insulin resistance and significantly elevate the risk of developing diabetes.