How do we know that statins are diabetogenic, and why? Is it an important issue in the clinical practice?

There is no doubt nowadays that statins exert a diabetogenic action. The evidence comes from observational studies, randomised trials, and meta-analyses. The relationship between statin use and new-onset type 2 diabetes is associated with statin potency and dose. It seems also to be stronger if the lowering effect is stronger and the low-density lipoprotein cholesterol level achieved is lower. The mechanisms underlying the development of diabetes in statin-treated patients are not completely understood. Generally, the increased insulin resistance and decreased insulin secretion are taken into account. However, it should be kept in mind that the cardiovascular risk reduction effect of statins outweighs the harm related to diabetes induction. The patients at risk of diabetes development should be monitored with regard to the parameters of glucose metabolism. The introduction of preventive lifestyle modifications to prevent diabetes is recommended. New-onset diabetes should be managed according to the guidelines.