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Statin therapy on glycemic control in type 2 diabetic patients: A network meta‐analysis
Author(s) -
Cui J. Y.,
Zhou R. R.,
Han S.,
Wang T. S.,
Wang L. Q.,
Xie X. H.
Publication year - 2018
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.12690
Subject(s) - medicine , rosuvastatin , atorvastatin , glycemic , statin , meta analysis , placebo , type 2 diabetes mellitus , diabetes mellitus , type 2 diabetes , randomized controlled trial , endocrinology , insulin , alternative medicine , pathology
Summary What is known and objective Statins are the cornerstone of primary and secondary prevention of cardiovascular diseases ( CVD s) and are effective for the prevention of vascular events in diabetic patients. Diabetes mellitus is an important risk factor for CVD s .The majority of patients with diabetes mellitus benefits from statin therapy. According to the recent clinical guidelines of the American College of Cardiology and the American Heart Association, moderate‐intensity or high‐intensity statin therapy should be used as the primary prevention for individuals with diabetes mellitus, aged between 40 and 75 years and with low‐density lipoprotein cholesterol ( LDL ‐C) from 70 to 189 mg/ dL . The objective of this review was to compare the associations of individual statins with their adverse effects on glycemic control in patients with type 2 diabetes mellitus (T2 DM ). Methods MEDLINE , EMBASE and CENTRAL were searched from inception through March 2017. There were included randomized controlled trials comparing statins with placebo or active comparators in patients with T2 DM . The endpoints of interest were glycated haemoglobin A1 C (HbA1 C ) and fasting plasma glucose ( FPG ). We performed a pairwise meta‐analysis and a network meta‐analysis within a frequentist framework. The standard mean differences ( SMD ) and 95% confidence intervals ( CI ) were calculated. Results Twenty‐three trials were included. A significant increase in HbA1c was detected in the pairwise meta‐analysis when statins as a class were compared with placebo ( SMD : 0.11). Moderate‐intensity pitavastatin lowered HbA1c compared with moderate‐intensity atorvastatin ( SMD : −0.16), high‐intensity atorvastatin ( SMD : −0.77), moderate‐intensity rosuvastatin ( SMD : −0.16) and low‐intensity pravastatin ( SMD : −0.15). Moderate‐intensity simvastatin lowered HbA1c compared with high‐intensity rosuvastatin ( SMD : −0.45) and high‐intensity atorvastatin ( SMD : −0.77). High‐intensity atorvastatin elevated HbA1c compared with placebo ( SMD : 0.63), moderate‐intensity rosuvastatin ( SMD : 0.50), low‐intensity pravastatin ( SMD : 0.51) and moderate‐intensity atorvastatin ( SMD : 0.50). Moderate‐intensity pitavastatin has lowered FPG compared with placebo ( SMD : −0.55), moderate‐intensity rosuvastatin ( SMD : −0.65), moderate‐intensity atorvastatin ( SMD : −0.65) and high‐intensity atorvastatin ( SMD : −1.25). High‐intensity atorvastatin has elevated FPG compared with placebo ( SMD : 0.70), moderate‐intensity atorvastatin ( SMD : 0.60), moderate‐intensity rosuvastatin ( SMD : 0.60) and moderate‐intensity simvastatin ( SMD : 0.90). What is new and conclusion Statins were associated with an increase in HbA1c compared with placebo. In patients with T2 DM , moderate‐intensity pitavastatin improved the glycemic control whereas high‐intensity atorvastatin worsened it. Appropriate statins should be administered for patients with diabetes mellitus.