Statins associated with progression of diabetes

A retrospective study of veterans with diabetes found that those who started statin therapy were more likely to meet criteria for diabetes progression, such as initiation of insulin or an additional antihyperglycemic drug class, over time.

Statin use is associated with progression of diabetes, including initiation of insulin, according to a recent study.

Researchers used data from patients who regularly used the U.S. Department of Veterans Affairs system to perform a retrospective, matched-cohort study of associations between statin initiation and diabetes progression from fiscal years 2003 to 2015. Patients were included if they were at least 30 years of age and had received a diabetes diagnosis during the study period. Statin users were those who had started statins, and active comparators were those who had started treatment with H2-blockers or proton-pump inhibitors. The composite outcome of diabetes progression included new insulin initiation, increased number of glucose-lowering medication classes, at least five blood glucose measurements of at least 200 mg/dL (≥11.1 mmol/L), or a new diagnosis of ketoacidosis or uncontrolled diabetes. Results were published Oct. 4 by JAMA Internal Medicine.

Overall, 705,774 patients were eligible for the study. Of these, 83,022 pairs of statin users and active comparators were matched. The mean age in the matched cohort was 60.1 years, 78,712 (94.9%) were men, 1,715 (2.1%) were American Indian/Pacific Islander/Alaska Native, 570 (0.8%) were Asian, 17,890 (21.5%) were Black, and 56,633 (68.2%) were White. Statin users had filled prescriptions for statins for a mean of 5.3 years and filled 12,118,523 prescriptions for statins during the study. A total of 55.9% of statin users and 48.0% of active comparators met the criteria for the diabetes progression outcome (odds ratio, 1.37 [95% CI, 1.35 to 1.40]; P<0.001), and the statin cohort also had a significantly higher incidence of each individual component of the composite outcome.

The authors noted that the study was limited by its retrospective observational design and that patients who used statins might have been followed more closely, among other factors. “This retrospective matched-cohort study found that statin use was associated with diabetes progression, including greater likelihood of insulin treatment initiation, significant hyperglycemia, acute glycemic complications, and an increased number of prescriptions for glucose-lowering medication classes,” they wrote. They called for additional research to develop a risk-tailored approach to statin therapy that balances the drugs' cardiovascular benefits against the risk for diabetes progression.