The prevalence of type 2 diabetes appears to be significantly lower in patients with familial hypercholesterolemia than in their unaffected relatives, according to a report published online March 10 in JAMA.

In an observational cross-sectional analysis of data from a nationwide Dutch registry of familial hypercholesterolemia, the prevalence of type 2 diabetes was 1.75% in 25,137 patients with the disorder, compared with 2.93% in 38,183 of their unaffected relatives. If this finding is confirmed in further research, it would support the hypothesis that cellular cholesterol metabolism plays a role in the development of type 2 diabetes, “perhaps because increased intracellular cholesterol levels are detrimental for pancreatic beta-cell function,” said Dr. Joost Besseling of the department of vascular medicine, Academic Medical Centre, Amsterdam, and his associates.

Patients with familial hypercholesterolemia require strict clinical follow-up, and it has been noticed – but, until now, not substantiated – that they are less prone to developing type 2 diabetes.

In what they described as the first study to examine this relationship, Dr. Besseling and his colleagues found that the strong inverse association (odds ratio, 0.62; 95% confidence interval, 0.55-0.69) between familial hypercholesterolemia and type 2 diabetes was consistent across every subgroup they evaluated, regardless of patient age, statin use, smoking status, and other possible confounding factors.

In addition, they found that the severity of the genetic mutation underlying the familial hypercholesterolemia also correlated, in an inverse dose-response manner, with the prevalence of type 2 diabetes (JAMA 2015;313:1029-36).

If these findings are confirmed, “they might provide support for development of new approaches to the prevention and treatment of type 2 diabetes by improving function and survival of pancreatic beta cells,” the investigators said.