Cholesterol-lowering drugs called PCSK9 inhibitors do not worsen type 2 diabetes control during short-term follow-up, a new study reveals.
The trial also demonstrated that proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors did not increase the risk of type 2 diabetes in those without the condition at the start of the study.
PCSK9 inhibitors are a relatively new medication administered via monthly or bimonthly injection designed to lower LDL cholesterol. Because previous research has indicated a PCSK9 genetic variant is linked with prediabetes and type 2 diabetes, researchers decided to examine this link further.
Scientists from University of Campinas, Sao Paulo, Brazil identified 20 randomised trials, all 12 weeks long at least, which compared PCSK9 inhibitors to placebo. They monitored changes in HbA1c, blood sugar levels, and increased risk or incidents of worsening type 2 diabetes.
After an average follow-up of 42 weeks, patients in the drug group averaged slightly higher blood glucose levels and HbA1c compared to the placebo group. But these increases did not translate into increased risk of either new or worsening type 2 diabetes.
Whilst PCSK9 inhibitors weren’t linked with an increased risk of developing type 2 diabetes, trials longer than 48 weeks were excluded from this analysis. Therefore, any longer-term effects on diabetes risk and control would need to be investigated by longer trials.
“The increases in the glycemic indexes were very small, and we just have to [watch] for the future analyses of the trials, with longer follow-up, and see if there will be an increased risk of type 2 diabetes,” said lead author Dr Luiz Sérgio Carvalho.
Carvalho highlighted, however, that more intense lowering of LDL levels following PCSk9 inhibitor treatment was associated with new or worsening type 2 diabetes.
“The effect on type 2 diabetes was apparent only in individuals who achieved very low levels of LDL cholesterol after treatment,” he explained to Medscape Cardiology.
The findings have been presented at the European Society of Cardiology (ESC) 2017.

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