Statin Therapy May Lead to Diabetes Progression
JAMA Internal Medicine
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This retrospective study evaluated
the association between statin initiation and diabetes progression. Progression
of diabetes occurred in significantly more statin users. There was a
dose–response relationship with higher-intensity statin use.
The study examined 12 years of data
on patients covered by the Veterans Affairs health system and new-user and
active-comparator designs to assess associations between statin initiation and
diabetes progression from 2003 to 2015.
These findings indicate that statin
therapy in diabetic patients may lead to the progression of diabetes.
Statin users had a higher
likelihood of insulin treatment initiation, developing significant
hyperglycemia, experiencing acute glycemic complications, and being prescribed
an increased number of glucose-lowering medication classes.
Experts advised, clinicians should continue to use statin therapy as it’s reduce the myocardial infarction, stroke, and revascularization but of course, clinicians should monitor the glycemic parameters and manage them accordingly. The main goal of statin therapy is to prevent CV.
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Importance
Statin therapy has been associated
with increased insulin resistance; however, its clinical implications for
diabetes control among patients with diabetes is unknown.
Objective
To assess diabetes progression
after initiation of statin use in patients with diabetes.
Design, Setting, and Participants
This was a retrospective
matched-cohort study using new-user and active-comparator designs to assess associations
between statin initiation and diabetes progression in a national cohort of
patients covered by the US Department of Veterans Affairs from fiscal years
2003-2015. Patients included were 30 years or older; had been diagnosed with
diabetes during the study period; and were regular users of the Veterans
Affairs health system, with records of demographic information, clinical
encounters, vital signs, laboratory data, and medication usage.
Interventions
Treatment initiation with statins
(statin users) or with H2-blockers or proton pump inhibitors (active
comparators).
Main Outcomes and Measures
Diabetes progression composite
outcome comprised the following: new insulin initiation, increase in the number
of glucose-lowering medication classes, incidence of 5 or more measurements of
blood glucose of 200 mg/dL or greater, or a new diagnosis of ketoacidosis or
uncontrolled diabetes.
Results
From the 705 774 eligible patients,
we matched 83 022 pairs of statin users and active comparators; the matched
cohort had a mean (SD) age of 60.1 (11.6) years; 78 712 (94.9%) were men; 1715
(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 individuals.
Diabetes progression outcome occurred in 55.9% of statin users vs 48.0% of
active comparators. Each individual component of the composite outcome was
significantly higher among statin users. Secondary analysis demonstrated a
dose-response relationship with a higher intensity of low-density
lipoprotein-cholesterol lowering associated with greater diabetes progression.
Conclusions and Relevance
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. The risk-benefit ratio of statin use in
patients with diabetes should take into consideration its metabolic affects.
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