**3. Conclusions**

diabetes compared to those with diabetes. When compared to placebo, the onset of diabetes needed longer duration by 5,4 weeks in rosuvastatin (rosuvastatin, 84.3 weeks vs placebo, 89.7 weeks). The benefits on cardiovascular risk and total mortality in rosuvastatin group were

Furthermore, three recent meta-analyses of large-scale placebo-controlled and standard carecontrolled trials [82] showed approximately more than 10% increased risk for incident diabetes

On the other, recently the post hoc analysis of ATTEMPT study assesses the incidence of newonset diabetes over 3.5 years in patients with metabolic syndrome observed no differences in the new onset of diabetes in patients with statins (statins, 0.83 vs. placebo, 1.00/100 patientyears) from the general population [67, 85], and no differences in the new onset of diabetes between individuals with and without diabetic risk factors [84]. New-onset diabetes incidence and CVD events were negligible and not different from what is expected in the general

Park *et al.* [9] analysed the linkage of statins and the new-onset diabetes using meta-analysis in published large cohort studies in MEDLINE from 2000 to October 2013 with the following MESH terms and text key words alone or in combination were included: 3-hydroxy-3 methylglutaryl coenzyme A reductase inhibitors, HMG-CoA reductase inhibitors, statins, incident diabetes, new-onset diabetes, insulin resistance, impaired insulin secretion, metaanalysis, cohort study, and observational study written in English. Results of observational studies and meta-analyses show association of incident diabetes with statin use in patients with concomitant risk factors for diabetes. They concluded a possible association between statin use and incident diabetes in patients with underlying diabetes risk factors in available clinical data. Although study data may be insufficient to change the current practice paradigm, clinicians should vigilantly monitor for incident diabetes in patients on statins. Patients with a low risk of CVD and high risk of diabetes should reconsider statin use and focus on lifestyle management. Each statins has different effects on glucose metabolisms, and women and elderly persons are known at higher risk of diabetes. Therefore, various confounders related

Muscoqiuri, *et al.* [86] discussed the effects of statins on insulin sensitivity or insulin secretion, because statins deteriorates glycemic control may accelerate progression to diabetes via molecular mechanisms that impact insulin sensitivity and secretion. The weight of clinical evidence suggests a worsening effect of statins on insulin resistance and secretion, but basic science studies could not find a clear molecular explanation from searches of computerized databases, providing conflicting evidence regarding both the beneficial and the adverse effects

A number of meta-analyses conducted in recent years have demonstrated that the association is real but causality has not yet been proved [8]. And the underlying mechanisms for this

In summary, although many clinical studies have demonstrated that statins worsen glucose metabolism or cause the new onset of diabetes, the cardiovascular benefits of statin therapy

to adverse events, especially glucose metabolisms, should be considered

greater than the hazard of the new onset of diabetes [7].

associated with statin therapy. [83, 84]

of statin therapy on insulin sensitivity.

association remain unclear.

population. [85]

260 Treatment of Type 2 Diabetes

In 2014, Simic and Reiner [87] summarized benefits and side effects of stastins as follow; 1) reduction in cardiovascular mortality and morbidity even in patients with very high risk of cardiovascular disease; 2) myopathy and rhabdomyolysis as most important side effects; 3) liver injury as a side effects, which occurs occasionally but is reversible. On the other hand, statins also improve hepatic steatosis and liver injury in fatty liver diseases; 4) similarly, renal injury as a side effect, but also statins showed protective effects on renal injury [69] and majority of data have shown the beneficial effects on renal function [33, 50-53, 67. 72]. 5) statins increase the incidence of type 2 diabetes, especially in individuals with diabetic risk factors [78]. But the cardiovascular benefits of such a treatment by far exceed this risk. Therefore, currently many guidelines for treatments for dyslipidemia, diabetes concluded that the cardiovascular benefits of statins by far outweight non-cardiovascular harms in patients with cardiovascular risk. However, it should be needed to treat dyslipidemia and to make patients aware of the possible risk of developing type 2 diabetes or, if they already are diabetic, of worsening their metabolic control.
