Incident Type 2 Diabetes (T2D) Following Statin Initiation in Youth

Background/Synopsis Although the association between statin use and incident type 2 diabetes (T2D) in adults is well documented, similar observations have not been reported in youth (<18 years-of-age). Clinical experience suggests that statin-related side effects in youth are rare, even following 20 years of continuous use. There are, however, limited long-term high intensity statin trials in this population. In contrast, adults treated with statins often experience statin-associated myalgia, and incident T2D has been reported in approximately 10-12%; with 25-30% in those with other risk factors, including obesity. Despite their growing use in the pediatric population, to date, incident T2D has not been reported in youth treated with statins. Objective/Purpose We report two males, 12 and 14 years-old, who developed incident T2D while receiving a statin. Although potentially coincidental, clinicians should be aware of this complication, especially in youth at-risk of insulin resistance/T2D. Careful follow-up and monitoring is recommended. Methods We describe two adolescent males who, despite implementation of therapeutic lifestyle changes, had persistent dyslipidemia and were treated with a statin. Both developed T2D. Their clinical findings and family histories suggested a predisposition to insulin resistance/diabetes. We discuss the development of T2D in adults following statin initiation and the putative mechanism by which these changes occur. Results The parents of both males reported reasonable compliance with lifestyle changes and statin use, supported by follow-up laboratory test results. Standard American Diabetes Association criteria were used to confirm the diagnosis of diabetes. Conclusions Although not previously reported in youth, adults appear to have an increased risk of incident T2D with statin use, the occurrence of which may be dose related. Evidence suggests several mechanisms by which statins have been shown to adversely affect glucose homeostasis, thus potentially contributing to the development of T2D in our two males. While our findings may be coincidental, these cases serve as a reminder of the association between statin use and incident T2D reported in adults, and the importance of monitoring and follow-up. Reports of additional cases will aid our understanding of statin safety in this younger population, assist in counseling and help inform future clinical care. External Funding No Although the association between statin use and incident type 2 diabetes (T2D) in adults is well documented, similar observations have not been reported in youth (<18 years-of-age). Clinical experience suggests that statin-related side effects in youth are rare, even following 20 years of continuous use. There are, however, limited long-term high intensity statin trials in this population. In contrast, adults treated with statins often experience statin-associated myalgia, and incident T2D has been reported in approximately 10-12%; with 25-30% in those with other risk factors, including obesity. Despite their growing use in the pediatric population, to date, incident T2D has not been reported in youth treated with statins. We report two males, 12 and 14 years-old, who developed incident T2D while receiving a statin. Although potentially coincidental, clinicians should be aware of this complication, especially in youth at-risk of insulin resistance/T2D. Careful follow-up and monitoring is recommended. We describe two adolescent males who, despite implementation of therapeutic lifestyle changes, had persistent dyslipidemia and were treated with a statin. Both developed T2D. Their clinical findings and family histories suggested a predisposition to insulin resistance/diabetes. We discuss the development of T2D in adults following statin initiation and the putative mechanism by which these changes occur. The parents of both males reported reasonable compliance with lifestyle changes and statin use, supported by follow-up laboratory test results. Standard American Diabetes Association criteria were used to confirm the diagnosis of diabetes. Although not previously reported in youth, adults appear to have an increased risk of incident T2D with statin use, the occurrence of which may be dose related. Evidence suggests several mechanisms by which statins have been shown to adversely affect glucose homeostasis, thus potentially contributing to the development of T2D in our two males. While our findings may be coincidental, these cases serve as a reminder of the association between statin use and incident T2D reported in adults, and the importance of monitoring and follow-up. Reports of additional cases will aid our understanding of statin safety in this younger population, assist in counseling and help inform future clinical care.