實證醫學資料已經證實高血脂是造成心血管疾病的重要危險因子，而史塔丁類 (Statins，HMG-CoA reductase inhibitors) 降血脂治療可以有效減少心臟血管疾病。然而，最近有些研究指出，使用史塔丁可能影響糖尿病發生以及糖尿病病人血糖控制。WOSCOPS 研究發現使用pravastatin 可減少30% 的糖尿病發生，而HPS 和ASCOT-LLA 團隊分別研究simvastatin
和atorvastatin，結果兩種藥物對糖尿病新生的影響並無統計意義。JUPITOR 研究則指出使用rosuvastatin 可能增加新診斷糖尿病之機會。而整合分析告訴我們，使用史塔丁可能略增加新診斷糖尿病的機會，但是其預防心血管疾病的好處優於壞處，故仍建議使用史塔丁。至於史
塔丁對糖尿病病人之血糖控制，HPS 和CARDS 團隊分別研究simvastatin 和atorvastatin，結果並不影響糖化血色素，而大型觀測研究發現使用史塔丁會略增加糖尿病病人空腹血糖。另
外，本文也對其他種類的降血脂藥物進行討論，就已知文獻，膽酸結合樹脂 (bile acid sequestrantresin) 有助於糖尿病前期病人與糖尿病病人血糖控制；膽固醇吸收抑制劑 (ezetimibe) 似乎不影響空腹血糖與糖化血色素；菸鹼酸 (niacin，nicotinic acid) 可能使血糖或糖化血色素小幅上升，但其預防心血管疾病的好處仍優於壞處；纖維酸 (fibrates，fibric-acid derivatives) 中的benzafibrate 發現可降低新診斷糖尿病；N3 多元不飽和脂肪酸 (omega-3 polyunsaturated fattyacid) 若適量使用，不至於影響血糖控制。結論是某些種類的史塔丁或許略增加新發生之糖尿病個案，也對血糖略為增加，但史塔丁預防心血管疾病以及減少相關死亡率的效果絕對是肯定的，因此，只要定時監控血糖與血脂肪變化，臨床上仍建議可以安心使用史塔丁或其他降血脂藥物。

Evidence-based data has confirmed that hyperlipidemia is an important risk factor leading to development of cardiovascular diseases and treatment by statins can greatly reduce incidence of cardiovascular diseases.However, recent studies revealed that statin treatment may slightly increase new onset of diabetes and elevate blood glucose levels in patients with diabetes. Results from WOSCOPS found that pravastatin therapy resulted in a 30% reduction in the hazard of becoming diabetic. Use of simvastatin in HPS and atorvastatin in ASCOT-LLA showed that both of the statins did not influence the risk of newly diagnosed diabetes. On the contrary, the result from JUPITOR indicated that rosuvastatin may increase such risk. Findings from meta-analysis suggested that
using statins may slightly increase the risk of new onset of diabetes, but the benefit of preventing cardiovascular disease is greater than its harm. Thus, we suggest statin should be used clinically if needed. In patient with established diabetes, results from HPS and CARDS studies showed that simvastatin and atorvastatin didn’t alter levels of glycated hemoglobin. However, some other studies showed that use of statins may slightly increase fasting blood glucose levels. Furthermore, we also reviewed effects of other lipid lowering agents. In general, bile
acid sequestrant resin is helpful for blood glucose control in patients with pre-diabetes and diabetes. Ezetimibe doesn’t seem to influence fasting blood sugar and glycated hemoglobin. Niacin may slightly increase levels of blood glucose and glycated hemoglobin, but its benefit in preventing cardiovascular diseases is also greater than its disadvantage. Benzafibrate, one of fibrate, were found to reduce the risk of new onset of diabetes. Omega-3 polyunsaturated fatty acid is not going to affect blood sugar control if the dosage is adequate. In conclusion, use
of statins reduces cardiovascular events in subjects with prediabetes and diabetes, although some of them might increase risk of new diabetes and worse glycemic control. In consideration of its risk and benefit, carefully use of statins with regular monitoring of glucose and lipids level in those individuals is warranted.