Statins and Diuretics May Increase Diabetes in High-Risk Patients

Patients with impaired glucose tolerance who take diuretics or statins may be at increased risk of new-onset diabetes, reports a study in the British Medical Journal.

The authors reanalyzed serial data on glucose levels from the “Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research” (NAVIGATOR) trial. The rates of new-onset diabetes were assessed for patients with no baseline history of treatment with β-blockers (5640 patients), diuretics (6346 patients), and statins (6146 patients). Another 6294 patients with no history of treatment with calcium channel blockers were studied as a “metabolically neutral” control group.

At a median follow-up time of 5 years, treatment with β -blockers was started in 16.2 percent of patients, diuretics in 20.7 percent, statins in 22.0 percent, and calcium channel blockers in 18.6 percent. After adjustment for baseline factors and time-varying confounders, both diuretics and statins were associated with an increased risk of new-onset diabetes: hazard ratio 1.23 and 1.32, respectively.

The risk of diabetes was not increased for patients starting treatment with β -blockers or, as expected, calcium channel blockers.

Impaired glucose tolerance may be a risk factor for the development of diabetes during treatment with certain classes of medication. This reanalysis of randomized trial data shows a significant increase in the risk of new-onset diabetes with diuretics and statins.

Although there is no significant association with β -blockers, the authors term this effect “indeterminate.” They conclude: “Our findings suggest that glycaemia should be better monitored when these drugs are initiated in high risk patients” [Shen L, et al. Role of diuretics, β blockers, and statins in increasing the risk of diabetes in patients with impaired glucose tolerance: Reanalysis of data from the NAVIGATOR study. BMJ 2013; 347:f6745].