Statins are associated with new onset type 2 diabetes mellitus (T2DM) in Medicare patients ≥65 years

Abstract

Background To evaluate the association of statins and co‐morbidities with new onset type 2 diabetes mellitus (T2DM) in patients 65 years and older. Methods This retrospective study used de‐identified administrative healthcare claims and enrolment data from a Medicare Advantage Prescription Drug (MAPD) health plan offered by a large multistate healthcare company. The plan covered >2.4 million individuals, of whom >1.7 million individuals were ≥65 years. Of these, 265 554 individuals had continuous MAPD enrolment January 2008 to December 2015. The unadjusted model assessed demographic, pharmacy and T2DM co‐morbidities as covariates. Significant variables (P < .05) in the unadjusted model were then included in the adjusted model. The adjusted model used Cox proportional hazards to evaluate covariate effects. Matched propensity score analysis was used to analyse the association of statins and T2DM onset. Results The cumulative rate of diagnosed T2DM onset in the study cohort was 4.82% (4314/89 390). Annualised incidence of T2DM diagnosis was 0.82%, 0.88%, 1.04% and 2.09% in 2012, 2013, 2014 and 2015, respectively. T2DM onset was associated with male sex, non‐white (African American or Hispanic ethnicity), statin use, hypertension, hyperlipidaemia, heart failure, lower limb ulceration, atherosclerosis, other retinopathy, angina pectoris, poor vision and blindness and absence ischaemic heart disease (IHD). Matched propensity score analysis showed that statin use was significantly associated with T2DM onset (Odds Ratio = 1.26, 95% Confidence Interval: 1.12‐1.41, P < .0001) in the adjusted model. Conclusions Analyses indicated that statin usage was associated with new onset T2DM after adjusting for covariates.

Effect of Statin Therapy on Diabetes Retinopathy in People With Type 2 Diabetes Mellitus: A Meta-Analysis

“…Statin may increase the prevalence of new-onset DMs. 12 The disadvantage of statin may be explained by the complex mechanisms of statin including increased insulin resistance or impaired insulin secretion. 43 The insulin resistance in patients with T2DM can lead to the abnormalities in lipoprotein transport.…”

“…11 However, some studies indicated that statins may increase the prevalence of new-onset DMs. [12][13][14][15][16] Moreover, statin use might increase the level of plasma glucose 17 which can elevate the risk of DR in patients with DM. Intensive therapy slows the progression of DR in patients with insulindependent DM.…”

The association between circulatory, local pancreatic PCSK9 and type 2 diabetes mellitus: The effects of antidiabetic drugs on PCSK9

“…Nevertheless, excessive reduction in LDL-C levels has been associated with the risk of new-onset diabetes mellitus (NODM) [ 22 ]. Consistently, studies have found that statins, well-known powerful lipid-lowering agents that primarily lower LDL-C, can induce NODM, increase insulin resistance, and lead to an inability to maintain compensatory insulin secretion [ 23 , 24 ]. Owing to the excellent lipid-lowering ability of PCSK9 monoclonal antibodies (alirocumab and evolocumab), their effects on NODM warrant long-term assessment and research.…”

Traditional Therapeutics and Potential Epidrugs for CVD: Why Not Both?

“…Although statin therapy is proven to be effective in the management of dyslipidemia and the reduction in mortality in patients with CVDs, poor adherence due to their side effects such as statin-related myopathies, potential liver damage, and memory loss have proven to be limiting factors for the use of this class of medication [114]. There is also evidence of the onset of T2DM with statin therapy; however, the findings of these studies are still controversial [75,115,116]. Specifically, characteristics such as the type of statin-for example, rosuvastatin or atorvastatin, -age, and other risk factors have been exhibited to contribute to this onset [117].…”