Bardini Gianluca, Giannini Stefano, Rotella Carlo Maria, Pala Laura, Cresci Barbara, Mannucci Edoardo
Department of Biomedical Clinical and Experimental Sciences, University of Florence, Italy.
Diabetology Unit, Careggi Hospital, Florence, Italy.
Diabetes Res Clin Pract. 2016 Oct;120:104-10. doi: 10.1016/j.diabres.2016.07.015. Epub 2016 Jul 30.
Evidences showed a link between statins and new-onset diabetes and large clinical trials in type 2 diabetes (T2DM) suggested a mild glycemic progression in statin treated. Since this effect has not yet elucidated in real world, we investigated the effects of different statins on glycemia in T2DM clinic outpatients.
In a retrospective cohort study, we recorded at 6 and 12months modifications of fasting glucose (FPG), HbA1c, diabetes intensification therapy and target rate for HbA1c in 421 T2DM non-users and new statin users. Statins were categorized with low or high potency.
Compared to statin users, no statin group showed a significant HbA1c reduction from 52.8±14.0mmol/mol to 48.2±8.5 (p=0.003) at 6months and 48.6±8.8 (p=0.007) at 12months. This trend without statins was also observed in FPG starting from 7.1±2.0mmol/l to 6.7±1.6 (p=0.12) at 6months and 6.6±1.5 (p=0.032) at 12months. Statins determined a significant diabetes treatment intensification: 48.7% vs 27.4% (p=0.002) with hazard ratio 2.4 [95% CI 1.14-5.2], p=0.022. HbA1c target was significantly lower in statin users 62.0% vs 75.4%, p=0.042. Only lower-potency statins showed a significant reduction of HbA1c from 52.0±11.1mmol/mol to 50.7±9.0 (p=0.017) and 50.7±9.5 (p=0.038) at 6 and 12months, respectively. The same effect for these statins was registered in FPG from 7.5±2.2mmol/l to 7.0±1.6 (p=0.021) at 6months and 7.2±1.5 (p=0.026) at 12months.
In patients receiving statin therapy a greater intensification diabetes therapy is need. This impact seems to be less pronounced by statins with lower potency.
有证据表明他汀类药物与新发糖尿病之间存在联系，而在2型糖尿病（T2DM）中的大型临床试验表明，接受他汀类药物治疗的患者血糖有轻度进展。由于这一效应在现实世界中尚未阐明，我们研究了不同他汀类药物对T2DM门诊患者血糖的影响。
在一项回顾性队列研究中，我们记录了421名未使用他汀类药物的T2DM患者和新使用他汀类药物的患者在6个月和12个月时空腹血糖（FPG）、糖化血红蛋白（HbA1c）的变化、糖尿病强化治疗情况以及HbA1c的达标率。他汀类药物按低强度或高强度分类。
与使用他汀类药物的患者相比，未使用他汀类药物组在6个月时HbA1c从52.8±14.0mmol/mol显著降至48.2±8.5（p = 0.003），在12个月时降至48.6±8.8（p = 0.007）。FPG也观察到了类似的无他汀类药物治疗的趋势，从6个月时的7.1±2.0mmol/l降至6.7±1.6（p = 0.12），在12个月时降至6.6±1.5（p = 0.032）。他汀类药物导致糖尿病治疗显著强化：48.7%对27.4%（p = 0.002），风险比为2.4[95%置信区间1.14 - 5.2]，p = 0.022。使用他汀类药物的患者HbA1c达标率显著更低，为62.0%对75.4%，p = 0.042。只有低强度他汀类药物在6个月和12个月时HbA1c分别从52.0±11.1mmol/mol显著降至50.7±9.0（p = 0.017）和50.7±9.5（p = 0.038）。这些他汀类药物在FPG方面也有相同效果，6个月时从7.5±2.2mmol/l降至7.0±1.6（p = 0.021），12个月时降至7.2±1.5（p = 0.026）。
在接受他汀类药物治疗的患者中，需要更强化的糖尿病治疗。这种影响在低强度他汀类药物中似乎不太明显。
