Recommendations for the Use of Statins in Patients with Diabetes Mellitus or Prediabetes. Conclusions of a Consensus Group

The contribution of statins in the treatment of cardiovascular risk of lipid origin has been a determining factor in the reduction of morbimortality from cardiovascular diseases due to a decrease in risk. However, statins are not exempt from possible adverse effects. One of them is their capacity to cause disorders in the carbohydrate metabolism, increasing the risk of new-onset diabetes in patients treated with statins significantly, although the cardiovascular benefit of their use is always higher. Yet, especially in diabetic or pre-diabetic patients, the statin of choice may condition the safety in this area, given that the diabetogenic profile of the different molecules differ. In particular, the objectives of this study were to summarize the expert's opinion on whether all statins have a similar or different diabetogenic effect and to establish recommendations on the statin selection based on the patient characteristics. In order to ascertain the opinion of the experts (primary care physicians and other specialists with experience in the management of this type of patient) we conducted a Delphi study to evaluate the consensus rate on diverse aspects related to the diabetogenicity of different statins, and the factors that influence their choice. On the basis of the consensus agreements reached among practitioners of different specialities, and considering the availability of greater and better scientific evidence, this work groups together the recommendations to consider when selecting a statin in individuals with prediabetes or diagnosed diabetes. Such recommendations are grouped in relation with the patient, each individual's own carbohydrate metabolism, and the specific characteristics of every statin. These recommendations could facilitate the rational use of one statin or another in order diminish the diabetogenic potential shown by some of them.