The reduction of CoQ10 following statin therapy is considered a possible mechanism for muscle-related adverse events and may be related to risk of incident diabetes. CoQ10 has been found to be deficient in patients with diabetes and may be able to counteract various metabolic disturbances associated with insulin resistance. Recent meta-analyses have shown the increase in risk of incident diabetes following treatment with statins is dose-dependent and statin-dependent. Lipoprotein Insulin Resistance (LPIR) is a new biomarker strongly associated with increased insulin resistance and potentially incident diabetes and may be an early indicator of type 2 diabetes risk. Pitavastatin showed the smallest reduction in CoQ10 as well as greatest reduction in LPIR compared to atorvastatin and rosuvastatin. Pitavastatin may be preferred when considering a statin therapy for patients needing potent LDL-C and LDL-P reduction but at risk of developing diabetes. Further studies are necessary to determine the clinically relevant changes in levels of CoQ10 and in markers of insulin resistance and incident diabetes with statin therapy when considering treatment regimens.