Statin use linked to diabetes progression

Among patients with diabetes, those who used statins were significantly more likely to experience diabetes progression than those who did not use statins, a retrospective matched-cohort study showed.

Statin therapy has previously been linked to insulin resistance, but research on the association between statin use and glycemic control is limited, Ishak A. Mansi, MD, a professor of internal medicine at UT Southwestern Medical Center, and colleagues wrote. To fill the data gap, the researchers matched 83,022 pairs of statin users with active comparators, all of whom had diabetes, culled from U.S. Veterans Affairs patient panels.

The statin user cohort consisted of those who started statin therapy from 2003 to 2015, while the active comparator cohort consisted of those who started using an H2-blocker or proton pump inhibitor and were not prescribed a statin during the study. The mean age of all patients was 60.1 years, 94.9% were men and 68.2% were white.

Diabetes progression occurred in 55.9% of the statin cohort vs. 48% of the active comparator cohort (OR = 1.37; 95% CI, 1.35-1.4), Mansi and colleagues reported in JAMA Internal Medicine. During the study period, the statin cohort had higher rates of glucose-lowering medication classes (OR =1.41; 95% CI, 1.38-1.43), new insulin starts (OR = 1.16; 95% CI, 1.12-1.19), persistent hyperglycemia (OR = 1.13; 95% CI, 1.1-1.16) and new diagnosis of ketoacidosis or uncontrolled diabetes (OR = 1.24; 95% CI, 1.19-1.3) than the active comparator cohort. Also, the adjusted OR of diabetes progression was 1.83, 1.55 and 1.45 for high-, moderate- and low-intensity cholesterol-lowering medication users, respectively.

“The higher risk of diabetes progression associated with statin use may seem less consequential, at least in the short and intermediate term, than the cardiovascular benefits of statin use, especially when used for secondary prevention,” Mansi and colleagues wrote. “However, diabetes progression has long-term effects on quality of life and treatment burden, which warrant consideration when discussing the overall risk-benefit profile, especially when used for primary prevention.”

Mansi and colleagues called for more research that develops “a risk-tailored approach to balancing the cardiovascular benefits of statin therapy with its risk of diabetes progression.”