Svena asked
I am taking simvastatin 10mg, lisinopril/Hctz 20/25mg, and atenolol 25mg. I have recently been diagnosed with type 2 diabetes. Can taking these drugs be part of the cause. I do have a family history of diabetes and am overweight. I go to the gym 5 times a week.
Answer
Out of the medications you listed, both simvastatin and hydrochlorothiazide (HCTZ) have been known to cause an increase in blood sugar (hyperglycemia) and a possible increased likelihood of developing diabetes. In many of the studies that have been done regarding the issue, it's always been tough to conclude that either is a significant CAUSE of diabetes since patients that are hypertensive and have high cholesterol are statistically more likely to have diabetes anyway, regardless if they are taking something that is known to cause an increase in blood sugar. Let's tackle each drug separately.
The class that HCTZ is in, known as thiazide diuretics, is linked with an increased the risk of hyperglycemia and in fact, with new-onset diabetes. It's very possible that HCTZ could be a contributing factor to your newly diagnosed diabetes. Having said that, thiazide diuretics are only considered a small risk factor for diabetes and typically if the medication were to be stopped or never taken, many patients would develop diabetes at some point in their lives anyway if they were at significant risk for it.
Medical guidelines and recommendations are somewhat muddled when it comes to thiazide diuretics and diabetes. The top two guidelines for hypertension treatment in diabetics come from Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the American Diabetes Association. Both of these guidelines in fact recommend thiazide diruetics in patients with diabetes either alone or in combination with other medication for treatment. So while thiazide diuretics can cause a small increase in blood sugar, the decrease in negative cardiovascular outcomes with controlled blood pressure is viewed as most important.
In regards to simvastatin, a large analysis was done looking over the data from 13 different trials. All in all, this analysis looked at over 90,000 people which is a fairly significant amount for a drug analysis. The data from the analysis showed a 9% increase in the likelihood of the development of diabetes in patients taking a statin medication. The study noted that the risk of diabetes was much higher in the so called "high diabetes risk group" which includes people that are over 70,have existing cardiovascular disease or have had a heart attack in the past 6 months.
Based on all the information that is written here, it does almost seem counter-intuitive to be giving statin medications (simvastatin is considered a stain medication) and thiazide medications to those with diabetes. Most data however points to the addition of these agents in patients with or without diabetes to be beneficial for cardiovascular risk. As with any medication, the increased risk of diabetes should be considered when initiating simvastatin therapy and thiazide therapy.
Having a family history of diabetes is a significant risk factor for getting diabetes yourself and is a cardiovascular risk factor. I don't have all of your history, but it seems as though your current therapy is in line with all of the medical guidelines out there. I would certainly bring some of your concerns to your doctor to see how your blood sugar could possibly affected by some therapy changes for you.
