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Electronic letters published:
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif){kind=icon}
Statins in the Diabetic Population
drug interactions in lipid-lowering trreatment in diabetes
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Michael Weintraub, MD New York Medical College
Send rapid response to journal:
miwneuro{at}pol.net Michael Weintraub
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The new Guidelines and Recommendations that moderate doses of statins be used in diabetics in an attempt to reduce the markedly elevated risks of cardiovascular disease is extremely important.1,2 Despite the statement that these drugs are extremely safe, they can produce side-effects of polyneuropathy3,4 and myopathy/rhabdomyolysis5 that could potentially lead to major disabilities, etc. Both of these side-effects are inherent to all statins and occur with a frequency of 4-5/10,000 with polyneuropathy and 2-3/10,000 in the non-diabetic population.6 It is theorized that the hydroxy methyl glutaryl coenzyme A(hmg-CoA) reductase inhibitor interferes with cholesterol synthesis in the nerve membrane producing aspects of axonal sensory and motor changes.3 Since diabetic peripheral neuropathy, depending on criteria, can be seen in 50-90% of individuals with diabetes for more than 10 years,7 the potential exists for early emergence in the clinically “asymptomatic” group or greater severity in the “symptomatic” group. Currently, there are no clinical studies available with endoneural nerve fiber biopsy parameters to address these potential issues. It is unclear what the ideal strategy will be for patients with symptomatic diabetic peripheral neuropathy and perhaps physicians should consider other options such as the use of policosanol (sugarcane extract of median-chain alcohol)8 or niacin9 in these symptomatic individuals. Both of these drugs not only lower cholesterol and LDL but also raise HDL. REFERENCES 1. Snow V, Aronson MD, Hornbake ER, et al: Lipid control in the management of Type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians. An Int Med 2004; 140:644-649. 2. Dijan S, Hayward RA: Pharmacologic lipid-lowering therapy in Type 2 diabetes mellitus: Background paper for the American College of Physicians. An Int Med 2004; 140:650-658. 3. Gaist B, Jeppesen U, Andersen M, et al: Statins and risk of polyneuropathy. A case-controlled study. Neurology 2002; 58:1333-1337. 4. Donaghy N: Assessing the risk of drug-induced neurologic disorders. Statins and neuropathy. Neurology 2002; 58:1321-1322. 5. Phillips PS, Hahs RH, Bannykh S, et al: Statin-associated myopathy with normal creatine, kanase levels. An Int Med 2002; 137:581-585. 6. Moosmann B, Behl C: Selenoprotein synthesis and side-effects of statins. Lancet 2004; 363:892-894. 7. Weintraub MI, Wolfe GI, Barohn RA, et al: Static magnetic field therapy for symptomatic diabetic neuropathy: a randomized, double-blind, placebo-control trial. Arch Phys Med Rehabil 2003; 84:736-746. 8. Sasser H, Barringer T: Policosanol: a natural alternative for lipid management? Alt Med Alert 2004; 7:37-48. 9. McKenney J: New perspectives on the use of niacin in the treatment of lipid disorders. Arch Int Med 2004; 164:697-705. Conflict of Interest:None declared |
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George B. Perlstein, M.D. none
Send rapid response to journal:
geoperl{at}soltec.net George B. Perlstein
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Since statins and many of the new oral glucose lowering agents both affect liver metabolism, should we not be cautious in using both agents together, fearing risk of hepatic injury? Conflict of Interest:None declared |
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