engleski

Statin treatment is associated with insulin sensitivity decrease in type 1 diabetes mellitus : a prospective, observational 56 month follow-up study

Objective: Statins are effective in the primary and secondary prevention of cardiovascular events in individuals with and without diabetes mellitus. Emerging evidence, however, suggest that statins might reduce insulin sensitivity and secretion in healthy population as well as in type 2 diabetes. We wanted to investigate the effect of statin therapy introduction on insulin sensitivity in type 1 diabetes mellitus (T1DM) patients. Methods: This prospective observational 56 months long study included 832 randomly selected T1DM patients aged 25-61 years. Uncontrolled dyslipidemia and clinician perceived need for treatment, rather than randomization, was basis for individuals being started on either atorvastatin or simvastatin (10-40 mg) ; N=345, 41.47%. Patients on statin treatment were compared to those unexposed to statin. Insulin sensitivity was accessed using equation derived from euglycemic- hyperinsulinemic clamp studies estimated glucose disposal rate (eGDR). Results: Patients who started statin therapy (59.42% atorvastatin and 40.58% simvastatin) experienced a greater decrease in insulin sensitivity (19.27 % vs 12.82 % p<0.001) as well as metabolic control deterioration compared to statin free group. The risk of decrease in insulin sensitivity attributable to statin use was 36.7% (HR 1.36 (95% CI 1.31, 1.43) after adjustment for age, gender, disease duration, smoking status and the concomitant antihypertensive therapy. Conclusion: Although there is still a lack of a clear molecular explanation on the adverse effects of statin therapy on insulin sensitivity, we showed that it deteriorates insulin sensitivity and metabolic control in type 1 DM. The cardiovascular benefits of statin treatment might outweigh the risk of developing insulin resistance, but the possible metabolic control worsening merits to be considered.

type 1 diabetes mellitus ; inuslin sensitivity ; statins

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