Do statins interfere with lifestyle intervention in the prevention of diabetes in primary healthcare? One-year follow-up of the FIN-D2D project

Rautio N, Jokelainen J, Oksa H, et al. Do statins interfere with lifestyle intervention in the prevention of diabetes in primary healthcare? One-year follow-up of the FIN-D2D project. BMJ Open. 2012;2(5). pii: e001472. doi: 10.1136/bmjopen-2012-001472.  

Background
Treatment with statins has been linked to an increased risk for type 2 diabetes in several post-hoc evaluations of previous completed trials,1-2 leading to controversy regarding the risk/benefit profile of statin therapy for primary prevention in patients who are at low risk for developing cardiovascular (CV) events.

FIN-D2D Design
Rautio and colleagues examined whether statin treatment was associated with type 2 diabetes incidence and changes in glucose metabolism among patients in the Programme for the Prevention of T2D in Finland 2003-2008 (FIN-D2D). Subjects in this observational, prospective follow-up study were at high risk for developing type 2 diabetes* and received lifestyle interventions (group or individual counseling sessions) over 1-year of follow-up.

Self-reported data from 2,798 subjects were analyzed; 484 (17.3%) subjects were using statins at baseline. The primary outcomes were type 2 diabetes incidence, and fasting and 2-h glucose measured at baseline and follow-up. (Click here for slide.) 

Findings at 1 Year
Diabetes incidence

Type 2 diabetes developed among 7.5% (n=31) of subjects using statins at baseline vs 6.5% (n=126) of subjects not taking statins at baseline. The incidence of type 2 diabetes did not differ between groups (odds ratio, 1.17; 95% confidence interval [CI], 0.78-1.76; P=0.442). (Click here for slide.) 

Glucose values
When glucose values were examined, a slight increaseof 0.08 mmol/L in fasting glucose was seen among statin users vs nonusers; the between-group difference was 0.074 mmol/L (95% CI, 0.14-0.134). This increase remained significant after adjustment for baseline factors including age, sex, fasting glucose, presence of CV disease, use of antihypertensive and/or coronary artery disease medication, weight, and one-year weight change. Decrease in 2-h glucose values, which reflect insulin sensitivity, was similar in both groups. (Click here for slide.) 

Baseline Characteristics
At baseline statin users were more likely to be older, male; had lower body mass index, diastolic blood pressure, total cholesterol, HDL-C, LDL-C; and had higher triglycerides, fasting glucose, and 2-h glucose vs nonusers.

*Deemed high risk based on their score on a modified version of the Finnish Diabetes Risk Score test

1. Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010;375(9716):735-742.
2. Preiss D, Seshasai SR, Welsh P, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA. 2011;305(24):2556-2564.   

 

 December 2012 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

Related content: 

Clinical Insights® in Diabetes :: November 2012 

Overview and slides: JUPITER Analysis: Do Statin Benefits Outweigh Diabetes Risk?  

Expert commentary: Peter Libby, MD, on the JUPITER analysis examining whether the benefits of statin use outweigh diabetes risk in primary prevention low-risk patients  

Overview and slides: Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials  

 

Last Modified: 11/15/2013