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NLM Director’s Comments Transcript
Diabetes and Statin Use: 07/09/2012

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

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More research is needed to understand why an increased risk of new-onset diabetes occurs when some adults take statins to control cholesterol levels, suggests a commentary recently published in the New England Journal of Medicine.

Allison Goldfine M.D., Harvard Medical School, finds there is an evidentiary vacuum regarding: the extent of a link between diabetes onset and statin use, its underlying biomedical mechanisms, and demographic dispersion.

Goldfine reports two highly-regarded studies (a large, nationwide statin clinical trial and a meta-analysis of six different statin trials) recently found 25 percent and 13 percent increases in the relative risk of new-onset diabetes among study participants who took statins to counter harmful cholesterol levels.

While Goldfine explains the discrepancies between the studies probably reflect methodological differences, the underlying issue is to obtain more reliable estimates about the diabetes risk from taking statins. While Goldfine writes the FDA currently finds (and we quote): ‘the cardiovascular benefits of statins outweigh these small increased risks’ (end of quote), she counters there is sufficient existing evidence to justify a more comprehensive assessment of the diabetes link.

Goldfine writes (and we quote): ‘No drug provides health benefits without some degree of risk, and risk-benefit assessments require ongoing review as new data become available’ (end of quote).

Goldfine explains some current research suggests aging, glucose levels in fasting adults, and intensive (versus moderate) statin dosage may be associated with early onset diabetes among statin users. Yet, she adds (and we quote): ‘we lack data showing that any specific subgroup of patients is uniquely at increased risk for statin–induced diabetes and should therefore not use statins’ (end of quote).

For example, Goldfine finds there is a dearth of current evidence about varying diabetes risks among women who take statins. She writes (and we quote): ‘Women have been either underrepresented or not included in several large, randomized trials, but the increased incidence of new–onset diabetes with statin use has also been seen among postmenopausal women in the Women’s Health Initiative observational study’ (end of quote).

Goldfine adds there is a need for basic research about the underlying biological mechanisms that may or may not explain why statin use leads to diabetes’ onset. Without basic research, it will be difficult to intervene successfully to prevent diabetes’ possible onset among statin users. Goldfine notes the need for basic research is illustrated by findings that suggest statins as a class of drugs impact the onset of diabetes regardless of different types of statin medications.

Overall, Goldfine suggests understanding the extent of diabetes risk is important since 24 million Americans take statins (often for prolonged periods) and about 8.3 million Americans have diabetes. Goldfine writes (and we quote): ‘Given the widespread use of statins, overestimating their clinical benefit or underestimating their risk is of potentially major importance to public health’ (end of quote).

While Goldfine acknowledges the Food and Drug Administration (FDA) recently added diabetes warning information to statin labels, she finds a need for the agency and researchers to further illuminate the extent of the risk.

Meanwhile, MedlinePlus.gov’s statins health topic page provides an evidence-based resource about the risks and benefits of statins. A helpful explanation about the benefits of statins to control harmful cholesterol (provided by the FDA) can be found in the ‘overviews’ section of MedlinePlus.gov’s statins health topic page.

MedlinePlus.gov’s statins health topic page additionally contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the statins health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.

To find MedlinePlus.gov’s statins health topic page, type ‘statins’ in the search box on MedlinePlus.gov’s home page, then, click on ‘Statins (National Library of Medicine).’

MedlinePlus.gov also contains related health topic pages on: cholesterol, diabetes, diabetes type 1, and diabetes type 2. Please follow MedlinePlus.gov to see if the type of research that Goldfine advocates emerges in the near future.

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A disclaimer – the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider. I want to take the opportunity to wish you a very happy holiday season and a healthy New Year. The National Library of Medicine and the 'Director's Comments' podcast staff, including Dr. Lindberg, appreciate your interest and company – and we hope to find new ways to serve you in 2012.

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