Using a retrospective, matched-cohort study that used new-user and active-comparator designs, investigators assessed statin initiative and diabetes progression in the patient population from fiscal year (FY) 2003 – FY 2015.
The study identified the statin user group as patients who initiated statin therapy within the study period, while the active comparator group was composed of patients who initiated an H2-blocker or proton pump inhibitor.
Further, the diabetes progression composite outcome was defined as the following: new insulin initiation or increase in number of glucose-lowering medication classes; new persistent hyperglycemia complications, including ≥5 measurements of blood glucose of 200 mg/dL, or a new diagnosis of diabetes with ketoacidosis or uncontrolled diabetes.
The team created a propensity score to match statin users and active comparators at a 1:1 ratio.Then, investigators compared the propensity score matched cohort using conditional logistic regression in calculation of odds ratios (OR) and 95% CI.
A total of 705,774 eligible VA patients were identified, composed of 595,579 statin users and 110,195 nonusers, leading to 83,022 matches of statin users and active comparators. The matched cohort had a mean age of 60.1 years with 78,712 men.
Further, investigators noted 1715 patients were American Indian/Pacific Islander/Alaska Native, 570 were Asian, 17,890 were Black, and 56,633 were White individuals.
Data show statin users had filled prescriptions for a mean of 5.3 years at a total of 12,118,523 prescriptions. In those considered nonusers, 52.176 patients used a statin during the study period and 58,019 (52.7%) never used a statin.
Investigators observed statin users had significantly higher odds of diabetes progression, in comparison to non-users.
They noted each component of the composite outcome had a higher rate among statin users compared with nonusers, including glucose-lowering medication classes, new insulin starts, presence of persistent hyperglycemia, and new diagnosis of ketoacidosis or uncontrolled diabetes.
A secondary analysis observed the odds of diabetes progression were higher in statin users compared to nonusers and higher than the overall cohort. Further, intensive cholesterol lowering had association with the highest odds of diabetes progression among statin users.
Although the higher risk of diabetes progression after statin use may seem less consequential in comparison to cardiovascular benefit, it is worth considering the risk-benefit ratio of statin use.
“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,” investigators wrote.