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Diuretics, beta-blockers and statins and new-onset type 2 diabetes.

Beta-blockers, diuretics and statins are established drugs in the management of cardiovascular disease and there is general consensus that statins reduce risk factors for coronary artery disease. However, there continues to be debate about their role in primary prevention in lower-risk populations. One of the main areas of controversy is the association of statins with new-onset type 2 diabetes. Shen et al., writing in the British Medical Journal, examined the degree to which using beta-blockers, statins and diuretics in patients with impaired glucose tolerance and other cardiovascular risk factors is associated with new-onset diabetes.

Their study focused on a re-analysis of data from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcome Research (NAVIGATOR) trial. This trial enrolled patients who, at baseline, were treatment naive to beta-blockers, diuretics, statins and calcium channel blockers, the latter being used as metabolically neutral controls.

Their main outcome measure was the development of new-onset diabetes diagnosed using standard plasma glucose levels in all participants, which was confirmed with glucose tolerance testing within 12 weeks.

During five years of follow-up, beta-blockers were prescribed to 915 patients, diuretics to 1 316, statins to 1 353 and calcium channel blockers to 1 171. After adjusting for confounders, the analysis found that both diuretics and statins were associated with an increased risk of new-onset diabetes, but beta-blockers and calcium channel blockers were not.

This study adds to the body of evidence that suggests that in high-risk patients with impaired glucose tolerance the use of diuretics and statins may be associated with an increased risk of new-onset diabetes.

Shen I., Shah BU, Keyes KM, et al. Role of diuretics, p blockers, and statins in increasing the risk of diabetes in patients with impaired glucose tolerance: Reanalysis of data from the NAVIGATOR study. Br Med I 2013;347:f6745. []

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Publication:South African Medical Journal
Article Type:Abstract
Geographic Code:6SOUT
Date:Feb 1, 2014
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