Friday, January 6, 2012

More on the idea of "fixing the 9 " Statins effect on glucose

"Fixing  the 9 " is a phrase I like . Fixing, is a common term in my home state of Texas .for example, I am fixing to go to town.The nine are the 9 risk factors those of us with diabetes and pre diabetes need to correct to recommended target goals to reduce our risk of heart disease and stroke. For the people without diabetes the number decreases to 6. What are those risk factors ? ( hint ,look at the last few days post).

The study below is good news for those of us concerned about the impact of Statins such as lipitor ( atovastatin)  and Crestor ( rosuvastatin ) on glucose control. The bottom line , if my math is correct ,is that there were very minimal increases  in  average A1c  .3  and Fasting blood glucose  6 mg/dl for atorvastatin and rosuvastatin . I think we can handle this when we compare that small correctable increase to the tremendous  benefit we gain by taking a statin.
                                Have fun , be smart ,  be healthy ," Fix the 9 "    David Calder, MD 

Diabet Med. 2011 Dec 12. doi: 10.1111/j.1464-5491.2011.03553.x. [Epub ahead of print]

Effects of rosuvastatin and atorvastatin on glycaemic control in Type 2 diabetes-the CORALL study.


Department of Internal Medicine/Diabetes Centre, Medical Centre Alkmaar, Alkmaar Internal Medicine, Maastricht University Hospital, Maastricht Department of Endocrinology and Metabolism, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.


Aims:  To examine whether high-dose statin therapy in Dutch European patients with Type 2 diabetes and dyslipidaemia influenced variables of glycaemic control. Methods:  The CORALL study, which was a 24-week, open-label, randomized, parallel-group, phase IIIb, multi-centre study, was designed to compare the cholesterol-lowering effects of rosuvastatin compared with atorvastatin in patients with Type 2 diabetes. Fasting plasma glucose levels and HbA(1c) levels were collected at baseline and at 6 and 18 weeks. Results:  Treatment with the highest dose of statins, i.e. atorvastatin 80 mg and rosuvastatin 40 mg at 18 weeks from baseline, was associated with increase in HbA(1c) levels; baseline 57 ± XX mmol/l (7.4 ± 1.0%) to 61 ± XX mmol/mol (7.7 ± 1.3%) (range 5.0-11.9) for atorvastatin (P = 0.003) and from baseline 60 ± XX mmol/mol (7.6 ± 1.0%) to 63 ± XX mmol/mol (7.9 ± 1.2%) (range 5.7-12.3) for rosuvastatin (P < 0.001). Mean fasting plasma glucose increased from baseline 8.7 ± 2.4 mmol/l to 9.5 ± 3.0 mmol/l upon treatment with atorvastatin 20 mg (P = 0.002) and 9.0 ± 3.0 mmol/l after treatment with 80 mg (not significant compared with baseline). The mean fasting plasma glucose did not change after treatment with rosuvastatin (9.1 ± 2.7 mmol/l at baseline, 8.9 ± 2.7 mmol/l with 10 mg, 9.4 ± 2.9 mmol/l with 40 mg). Conclusions:  Glycaemic control deteriorated in patients with diabetes following high-dose statin therapy. Future controlled studies are needed to verify these findings and, if confirmed, determine whether such changes represent a true decline in glycaemic control. Presently, it appears that, based on the overwhelming prospective trial data available, the preventive effect of statin therapy supersedes that of the slight increase in HbA(1c) . © 2011 The Authors. Diabetic Medicine© 2011 Diabetes UK.
© 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

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Your comments and questions are appreciated. David Calder,MD