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Statins are independently associated with increased HbA1c in type 1 diabetes – The Thousand & 1 Study

  • Magnus Thorsten Jensen
    Correspondence
    Corresponding author at: Department of Internal Medicine, Holbaek Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark. Tel.: +45 59484500; fax: +45 59437603.
    Affiliations
    Department of Internal Medicine, Holbaek Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark

    Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark

    Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark
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  • Henrik Ullits Andersen
    Affiliations
    Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark
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  • Peter Rossing
    Affiliations
    Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark

    Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health Sciences University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark

    Faculty of Health, University of Aarhus, Nordre Ringgade 1, 8000 Aarhus C, Denmark
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  • Jan Skov Jensen
    Affiliations
    Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark

    Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
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Published:October 21, 2015DOI:https://doi.org/10.1016/j.diabres.2015.10.022

      Highlights

      • Statin use has been associated with increased risk of developing type 2 diabetes (T2DM), and with impaired glycemic control in T2DM patients.
      • The association between statin use and glycemic control in type 1 diabetes (T1DM) is unknown.
      • In the present study of patients with T1DM, use of statins is independently associated with impaired glycemic control.
      • These results are the first in patients with T1DM, and may indicate a need to revisit dose of insulin when starting statin treatment.

      Abstract

      Aims

      Statin use has been associated with increased risk of developing type 2 diabetes (T2DM), and with impaired glycemic control in T2DM patients. The association between statin use and glycemic control in type 1 diabetes (T1DM) is unknown. The association between use of statins and glycemic control in T1DM patients without known heart disease was examined.

      Methods

      Cross-sectional study of 1093 T1DM patients from the outpatient clinic at Steno Diabetes Center. Physical examination, questionnaires, and echocardiography were performed in all patients. Investigators were blinded to all laboratory measurements. Data were analyzed in uni-and multivariable models.

      Results

      Mean age 49.6 years, 53% men, mean diabetes duration 25.5 years, 475 (43.5%) received statins. In baseline analyses statin users tended to be older, have longer diabetes duration, and have more severe kidney disease. Left ventricular ejection fraction was not associated with statin use. In multivariable models including age, gender, diabetes duration, BMI, blood pressure, physical activity, family history of cardiovascular disease, physical activity, albuminuria, eGFR, retinopathy, smoking, cholesterol, ejection fraction, triglycerides, and use of ACE/ATII-antagonists, aspirin, calcium-antagonists, betablockers or diuretics, statin use was independently and significantly associated with higher HbA1c (0.2% (95%CI: 0.1; 0.4) (2.0 mmol/mol (0.2; 3.8)), p = 0.029).

      Conclusions

      In T1DM, use of statins is independently associated with impaired glycemic control. A causal relationship cannot be determined from this study. Given the benefit on cardiovascular outcome, this should not cause patients to stop statin treatment, but may indicate a need to revisit dose of insulin when starting statin treatment.

      Abbreviations:

      T1DM (type 1 diabetes), LVEF (left ventricular ejection fraction), ICD (implantable cardioverter defibrillator)

      Keywords

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