Do statins lead to diabetes later in life?

DEAR DR. ROACH » I’ve been taking the statin Zocor for the past 30 years. I understand that one of the side effects is diabetes. I will be

84 in August, and

I have a family history of diabetes.

Last year, my A1C reading put me in the prediabetes range. I have remained active by walking, using small weights, etc., and I watch my calorie intake. I weigh 199 pounds at 5 feet, 11 inches tall. I was disappointed with a follow-up A1C reading because I thought my actions would take me out of the prediabetic range.

I’m aware that after 65, the pancreas produces less insulin. What are your recommendations?

— R.C.

ANSWER » For most older people with diabetes, resistance to insulin is the primary reason. This is opposed to decreased insulin output, although the pancreas does lose some ability to make insulin with age. The mechanisms by which statins predispose a person to diabetes are not clear, but they probably include both resistance to insulin and decreased production.

Regular exercise and a moderate diet are the mainstays of diabetes prevention. Since you are walking and weightlifting, diet is the most likely place where you might be able to make changes. Even so, it may not be possible to prevent diabetes entirely.

Visit a registered dietitian nutritionist for some personalized dietary advice.

Your body mass index, or BMI, is 27.8. A few pounds of weight lost — I really do mean just a few pounds — could reduce your risk of developing diabetes in the future, but you would want to lose weight the right way, through a healthy diet and regular exercise.

Even though statins increase the risk of developing diabetes in those people who are predisposed to developing diabetes, the benefit in preventing heart attack outweighs the risk.

That is, as long as statins are appropriately prescribed to people with existing heart disease or those at very high risk.

The benefits of statins in people with no known heart disease lessen with advancing age, and I seldom prescribe statins to people over 85 unless they are known to have blockages in the arteries.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.