Could Your Cholesterol Medication Cause Diabetes?

With any medication, there are benefits and risks that need to be considered.  Medications are generally recommended to a patient when the potential benefit of the medication is felt to be greater than the potential risks.

While it is extremely important for both doctors and patients to be well informed of potential side effects of medications, the media unfortunately loves to hype up side effects, often making it seem like the risks of taking a medication must outweigh any potential benefits.

Statins, a group of cholesterol medications, have taken a particular beating in the media over the years.   A colleague of mine approached me not too long ago saying that he was worried about his patients being afraid of taking their statin cholesterol medications because of fear of developing diabetes as a side effect, and asked me if I would publish a post on this topic.

An excellent review was published in The Lancet, which does a great job of addressing the question of benefit vs risk of statin therapy.

If 10,000 people are treated with statin therapy for 5 years: (with the example given of 40mg of atorvastatin (Lipitor) daily)

Benefits:

• if these 10,000 people had a past history of 'blocked arteries' (occlusive vascular disease) - eg prior heart attack or stroke: 1,000 would be saved from another heart attack or stroke
• if these 10,000 people had no history of vascular disease: 500 would be saved from a heart attack or stroke

Risks: 

• 50-100 will develop diabetes because of their statin
• 5-10 will have a bleeding type (hemorrhagic) stroke
• 5 will develop serious muscle complications

The risk of developing diabetes due to statin medications is higher with the more powerful statins (atorvastatin (Lipitor) and rosuvastatin (Crestor)), and with higher doses.  However, it is precisely these particular statins at the higher doses that have the biggest benefit to prevent heart attacks and strokes in people who have a past history of vascular disease.

People with risk factors for developing diabetes (eg, prediabetes, obesity) are at higher risk of statins tipping them up into diabetes range blood sugars. However, even if a person develops diabetes due to their statin, the health benefit in preventing heart attacks and strokes is much greater than the adverse effect of diabetes on their health, provided the diabetes is well managed.

For people who already have diabetes, statins also have a powerful benefit in preventing heart attacks and strokes, which is felt to far outweigh any small increase in blood sugars that may occur (and can be managed with adjustment to diabetes medication).

As to how statins increase the risk of developing diabetes, another study in The Lancet suggests that it may be related to the mechanism of statins to inhibit an enzyme called HMG CoA reductase, and may be genetically mediated.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2018

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Semaglutide - New Diabetes Medication With Superior Diabetes Control And Weight Loss - Now Approved In Canada

In the current era of type 2 diabetes, we are fortunate to have many different medications to choose from to help people control their blood sugars, choosing the medication(s) that fit each individual's unique health situation best.   In the last decade or so, we have developed diabetes medications that can avoid two unwanted side effects of some of the older diabetes medications: weight gain (with some causing weight loss), and low blood sugars.

Health Canada has just approved a new medication, called semaglutide, which is not only superior to any other medication it has been tested against for blood sugar control, but also causes more weight loss than any other medication on the market.

Semaglutide (trade name Ozempic) is a GLP1 receptor agonist, which works by stimulating the pancreas to increase insulin release and suppress the production of a hormone called glucagon, and also acts as an appetite suppressant in the hunger/fullness centre of the brain.  It is a once weekly treatment given by injection under the skin.  It reduces hemoglobin A1C (the diabetes report card) by up to 1.8%, and reduces weight in people with diabetes by up to 6.4 kg (14 lb) in the clinical trials that have been conducted.

In terms of side effects, like other GLP1 receptor agonists that are already available (including liraglutide (Victoza), dulaglutide (Trulicity) and exenatide (Bydureon or Byetta), it temporarily slows down stomach emptying, so can cause nausea, constipation, or diarrhea, which usually goes away after a few weeks, if it occurs.  Also similar to other GLP1s, there is a low risk of pancreatitis.

Unique to semaglutide, there was an increase in diabetic eye complications seen in the largest clinical trial (in which I was an investigator) , which is thought to be due to the power of semaglutide to greatly improve diabetes control (we have seen occasional temporary worsening of diabetic eye disease in studies of other medications, including insulin, when there is a big and rapid drop in blood sugars).  This risk is higher in people with existing diabetes eye complications.  However, long term improvement in diabetes control decrease the risk of diabetes eye complications overall.

Semaglutide has also been shown to reduce the risk of cardiovascular events in people with type 2 diabetes and cardiovascular disease - now the fourth diabetes medication available in Canada to show this benefit.  The full product monograph, with a full description of clinical trials and potential side effects, is available here.

Semaglutide is currently being studied as an obesity treatment as well, in people without diabetes, but is not yet approved for this indication.


Disclaimer: I am involved in research trials of semaglutide for type 2 diabetes and obesity.  I receive honoraria as a continuing medical education speaker and consultant from the makers of semaglutide (Novo Nordisk). 

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2018

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