Use of statins linked to progression of diabetes: JAMA

United States: A recent study in the JAMA Internal Medicine found statin use to be associated with progression of diabetes – statin users were more likely to have significant hyperglycemia, initiate insulin therapy, increase prescriptions for classes of hypoglycemic drugs and acute glycemic complications.

For the primary prevention of cardiovascular disease (CVD) in type 2 diabetic patients aged 40 to 75 years with low density lipoprotein (LDL) cholesterol (LDL) levels of 70 mg / dL or greater, the guidelines recommend a statin treatment. The use of statins has been linked to higher blood sugar levels and increased insulin resistance. However, its clinical implications for the control of diabetes in diabetic patients are unknown.

To fill this knowledge gap, Ishak A. Mansi, Department of Medicine, VA North Texas Health Care System, Dallas, and colleagues sought to assess the progression of diabetes after the start of statin use in diabetic patients in a paired retrospective cohort study.

The study included patients aged 30 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 use.

Interventions included initiating treatment with statins (statin users) or with H2 blockers or proton pump inhibitors (active comparators).

Of the 705,774 eligible patients, the researchers compared 83,022 pairs of statin users and active comparators; the matched cohort had a mean age of 60.1 years; 78,712 (94.9%) were male; 1,715 (2.1%) were American Indian / Pacific Islander / Alaskan native, 570 (0.8%) were Asians, 17,890 (21.5%) were Black and 56 633 (68.2%) were White.

The main findings include:

  • The outcome of diabetes progression occurred in 55.9% of statin users versus 48.0% of active comparators (odds ratio, 1.37).
  • Each individual component of the composite result was significantly higher in statin users.
  • Secondary analysis demonstrated a dose-response relationship with a higher intensity of lowering low-density lipoprotein-cholesterol associated with greater progression of diabetes.

“The risk-benefit ratio of statin use in diabetic patients must take into consideration its metabolic effects,” the authors wrote. “More research is needed to form a risk-informed approach to balance the cardiovascular benefits of statin therapy with its risk for progression to diabetes.”

Reference:

The study entitled “Association of Statin Therapy Initiation With Diabetes Progression: A Retrospective Matched-Cohort Study” is published in JAMA Internal Medicine.

DOI: 10.1001 / jamainternmed.2021.5714

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