Key takeaways
Repatha lowers your LDL cholesterol levels, reducing your risk of heart disease and stroke.
Clinical trial data show that Repatha is safe and effective for people with diabetes, who are already at a higher risk for cardiovascular disease because of their high blood sugar.
In rare cases, Repatha may slightly raise your blood sugar, so it’s important to monitor your glucose levels at home, especially in the first 6 months after starting this medication.
Managing diabetes is already a full-time job. So when your healthcare provider adds another prescription to the mix, it’s fair to wonder: Do I really need this, and is it safe? If you’ve just been prescribed Repatha (evolocumab) to help you bring your cholesterol levels down, here’s the short answer. Yes, it’s safe. Plus, it could be the most important medication you take.
Clinical trial data backs its use in people with diabetes, and research shows it can significantly cut your risk of heart disease and stroke, two of the most serious complications of living with diabetes. Here’s what you need to know about how it works, what to watch for, and why your cardiologist might seem pretty enthusiastic about this medication.
Why might a person with diabetes be prescribed Repatha?
Repatha is an injectable medication that helps lower your low-density lipoprotein cholesterol levels (LDL-C levels). LDL cholesterol is often referred to as the “bad” kind of cholesterol, since it raises your risk for atherosclerotic cardiovascular disease (ASCVD), including heart attack and stroke.
High LDL cholesterol and non-high-density lipoprotein cholesterol (non-HDL-C) levels are especially problematic for people with Type 1 diabetes, Type 2 diabetes, and prediabetes, who already have a higher risk of ASCVD, says University of Missouri Health Care cardiologist Mary Beth Fisher, DO. Because Repatha can reduce your LDL by up to 60%, Dr. Fisher says it’s important not to underestimate this medication’s benefits for people with diabetes.
Although it has a similar effect on cholesterol as statin medications, Repatha is not a statin. Statins work by blocking an enzyme that regulates cholesterol production in the liver. But Repatha is a PCSK9 inhibitor that works by blocking a protein that limits how much cholesterol your liver can eliminate from your blood.
Most people with high blood cholesterol take statins. They’re still considered the first-line treatment. But sometimes people don’t reach their LDL goal even with the highest tolerated statin dose, says Jossef Amirian, MD, a cardiologist with Manhattan Cardiology in New York City, and others can’t take statins at all due to side effects like muscle pain. For these people, Repatha can be used in addition to a statin or as a substitute for one.
Repatha is also prescribed by healthcare professionals as an adjunct to diet and exercise in high-risk patients with forms of dyslipidemia, including:
- Adults with heterozygous familial hypercholesterolemia (HeFH) (a genetic condition causing very high LDL-C) or ASCVD who need additional treatment beyond statin therapy.
- Patients with homozygous familial hypercholesterolemia (HoFH) (a rare, severe form of genetic high cholesterol) who require a more aggressive approach. Combining Repatha with other therapies, such as statins and ezetimibe.
Is Repatha safe to take if you have diabetes?
Yes, clinical trial data on Repatha show it’s safe for people with diabetes. It’s very effective at lowering cholesterol levels and is generally well-tolerated, says Dr. Fisher. More importantly, she adds, studies have not shown a clinically meaningful worsening of insulin resistance or an increase in diabetes rates with Repatha.
Most experts refer to the FOURIER trial, a randomized, double-blind, placebo-controlled trial of more than 27,000 people from across the United States and Europe. This trial looked at the drug’s effectiveness and safety for people with and without diabetes over a period of at least 8 years, and found that taking Repatha led to a 15 to 20% lower risk of major cardiovascular events (like heart attack and stroke) and a 23% lower risk of cardiac death.
Meanwhile, other studies examining the effects of Repatha specifically in people with diabetes confirm that the drug is effective. Plus, it does not cause changes in fasting blood sugar levels or hemoglobin A1c (HbA1c) over time.
Does Repatha raise blood sugar or cause diabetes?
Based on data from the FOURIER trial, Repatha could raise your blood sugar a small amount and may slightly increase your risk for new-onset diabetes. However, the risk is minimal. In the trial, new-onset diabetes occurred in 8.1% of people taking Repatha, compared to 7.7% of people taking a placebo. It’s also primarily only seen in the first six months after starting treatment with Repatha rather than as an ongoing risk.
It’s important to note that statins also carry a risk of increased blood sugar and new-onset diabetes, so Repatha isn’t riskier than statins in this way. Keep in mind, too, that untreated cholesterol and diabetes pose a larger risk to your health than any medications your provider prescribes to help you manage these conditions.
Common side effects of Repatha include a runny nose, a sore throat, flu-like symptoms, back pain, and increased blood sugar levels. Potential adverse reactions to Repatha include upper respiratory tract infections and injection site reactions. It is contraindicated in patients with a serious hypersensitivity reaction to evolocumab or any of the inactive ingredients in Repatha.
What should diabetics watch for while taking Repatha?
Per Dr. Fisher, the most common side effects of Repatha include injection site reactions and upper respiratory symptoms. Rarely, allergic reactions occur, causing hives, itching, swelling, and difficulty breathing or swallowing. This is a medical emergency. If you take Repatha and experience any of these symptoms, seek immediate medical attention.
Because Repatha is injected once every two weeks, injection site reactions can be the biggest issue for people with diabetes taking Repatha. “Diabetics, especially when their blood glucose is poorly controlled, are at increased risk of infection and poor wound healing,” says Dr. Amirian. “It’s extra important to pay attention to the injection site and make sure there is no pain, redness, swelling, or irritation, and contact your provider if you’re concerned about your injection site.”
Otherwise, make sure you and your healthcare provider talk about next steps and follow-up appointments. You will probably need to have your cholesterol levels checked about eight to 12 weeks after you start taking Repatha to make sure the medication is working for you, says Dr. Fisher. If you are already monitoring your blood glucose levels at home, you should continue unless your provider tells you otherwise. If you don’t regularly monitor your glucose at home, Dr. Amirian says you likely won’t need to start, but you may need to get your HbA1c levels checked more frequently until your body has adjusted to the medication.
How much does Repatha cost, and how can you save?
Repatha retails for about $700 per month, which could be totally out of your budget, especially if you’re also shouldering the cost of diabetes medication. But there are ways to save money on your Repatha prescription, regardless of your insurance coverage.
Most people with commercial insurance plans can apply for a copay card through the drug’s manufacturer, Amgen, and pay as little as $25 per month for their prescription. It’s important to note that the copay card has a limit of $2,500 per year, so depending on your insurance coverage and plan deductible, it may only provide savings for part of the year.
Uninsured or underinsured people taking Repatha aren’t eligible for the manufacturer’s copay card, but may be able to save a significant amount of money per month on their prescription by using a SingleCare coupon.
Save up to 80% on Repatha with SingleCare
Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.
No matter what your insurance situation is, you can always talk with your pharmacist if you’re having trouble affording your medications. There are many ways to save money on prescription drugs, and pharmacy staff can help you find one that works for you.
The bottom line
Clinical data show that Repatha is safe for people with diabetes to take and that it significantly lowers both cholesterol and cardiovascular disease risk. Although there is a small chance Repatha could raise your blood sugar, the benefits greatly outweigh the risks. This is especially true for people with diabetes, who are already more likely to experience heart disease, heart attack, and stroke.
If you have any concerns about taking Repatha as a person with diabetes, or about monitoring your blood sugar for changes while taking this medication, talk to your healthcare provider. If you are uninsured or underinsured and filling a Repatha prescription for the first time, head to our SingleCare coupon page to learn how to save on prescription costs.
- Long-term evolocumab in patients with established atherosclerotic cardiovascular disease, Circulation (2022)
- PCSK9 inhibitors in lipid management of patients with diabetes mellitus and high cardiovascular risk: A review, Journal of the American Heart Association (2018)
- Repatha® now indicated for adults at increased risk for major adverse cardiovascular events due to uncontrolled LDL-C, National Lipid Association (2025)
- PCSK9 inhibition and risk of diabetes: Should we worry?, Current Atherosclerosis Reports (2022)
- Statins and diabetes: What you should know, Centers for Disease Control and Prevention (2024)
- Repatha prescribing information, U.S. Food and Drug Administration (FDA)
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