Dear Editor,

I have read the research proposal “A Multi-Center, Open-Label, Two-Arm Parallel Group Non-inferiority Randomized Controlled Trial Evaluating the Effect of Pitavastatin, Compared to Atorvastatin, on Glucose Metabolism in Prediabetics with Hypertension and Dyslipidemia: Rationale and Design for the China Hemoglobin A1c Metabolism Protection Union Study (CAMPUS)” by Jhang J. et al., with great interest. The authors presented a clinical trial protocol proposal to compare the effect of pitavastatin and atorvastatin on glucose metabolism in prediabetics with hypertension and dyslipidemia [1]. I would like to request the authors to clarify or elucidate the following point for better understanding of the rationale and design.

Statins are better known for its diabetogenic potential by causing/altering inhibition of β-cell glucose transporters, β-cell apoptosis, pro-inflammatory and oxidative β-cell effects of plasma-derived cholesterol, delayed ATP production, decrease in the secretion of insulin, and decrease in adiponectin levels [2]. Hence, after adding statins to the prediabetics, causes increase in HbA1c levels exponentially; however, the authors did not mention about the rescue medication used for those sensitive patients [1].

I would be highly obliged for your kind consideration of the abovementioned clarification in your article to understand the effect of pitavastatin and atorvastatin on glucose metabolism in prediabetics with hypertension and dyslipidemia.