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Study links statins with more aggressive diabetes progression

Patients with diabetes who used statins experienced less control of their diabetes than patients who did not take statins, suggests a new retrospective study published in JAMA Internal Medicine.

Individuals who had diabetes and were prescribed statins had a higher chance of insulin treatment initiation, were more likely to develop significant hyperglycemia and experience acute glycemic complications, and were more likely to be prescribed extra glucose-lowering medications, according to the study results.

The overall increase in diabetes progression was 37% more compared to patients not taking statins.

“Given this increase, I was not surprised by the increased number of patients needing glucose-lowering medications or insulin,” said Kristi Kelley, PharmD, BCPS, BCACP, a clinical professor at Auburn University Harrison School of Pharmacy in Alabama. “I was surprised by the results of the secondary analysis showing that the odds of progression of diabetes was greatest with the high intensity statins.”

The study authors note that the “findings of the secondary analyses should be interpreted as exploratory.”

Statins are among the most-prescribed medications and are known to be associated with greater insulin resistance and higher blood glucose levels. FDA added a warning to all statins in 2012 that states that increases in A1C and fasting blood glucose have been noted in patients receiving statin therapy. In their 2019 scientific statement, the American Heart Association also acknowledged adverse events related to statins.

“This is something that is going to continue to be investigated and will be discussed among health care providers,” said Kelley.

In the JAMA Internal Medicine study, Mansi and colleagues analyzed 12 years (2003–2015) of data on patients covered through the VA health system. The study included roughly 83,000 propensity-scored matched pairs of statin users and nonusers. Since data originated within the VA health system, the overwhelming majority of participants were white men around 60 years old, which could limit the external validity of the results, according to Kelley.

The medical record data included inpatient and outpatient diagnoses and procedure codes, pharmacy and medication usage, vital signs records, and laboratory data.

For those who filled a statin prescription during the study period, roughly 63% of the prescriptions were for simvastatin, 12% for atorvastatin, 11% for rosuvastatin, and 10% for pravastatin.

“The biggest implication for this study is that further research is urgently needed to define the diabetes subpopulation that would benefit most from statin use and the subpopulation that may suffer most harm,” said Mansi, who is a staff internist at the VA North Texas Health System.

With over 34 million Americans currently living with diabetes, studies such as this one have major public health relevance.

Mansi noted that with statins in clinical use for more than 30 years, he would have expected such research to be done much sooner.

Loren Bonner, senior editor

For the full article, please visit www.pharmacytoday.org for the December 2021 issue of Pharmacy Today.

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