Abstract
Introduction
The association between statins and incident diabetes mellitus (DM) in observational
studies is much larger than that reported from randomized controlled trials. We sought
to assess this association using a novel design controlling for selection bias.
Methods
Using data from MarketScan, we identified a cohort of non-diabetic patients who initiated
a statin and matched them to patients not taking statins. From the statin-user cohort,
we identified two subgroups: patients who received statin refills for >6 months (continuers)
and patients who received statin refills <6 months (discontinuers). Patients were
followed for a minimum of two years to determine incident DM.
Results
We included 442,526 patients, divided equally between statin users and non-users.
Statin use was associated with increased DM (9.9% vs. 4.4%, HR 2.2, p < 0.001). Among the 221,263 statin users, there were 194,357 continuers and 26,906
discontinuers. There was no significant difference in the incidence rate of DM between
both groups (10.0% vs. 9.3%, HR 1.03, p = 0.22).
Conclusions
Statin use was strongly associated with incident diabetes when users were compared
to non-users but not when continuers were compared to discontinuers. Selection bias
confounds the association between statin use and incident diabetes in observational
studies.
Keywords
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Article Info
Publication History
Published online: September 09, 2022
Accepted:
August 30,
2022
Received:
February 27,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
