Association between statin exposure and diabetes incidence among privately-insured patients before and after applying a novel technique to control for selection bias.

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.

• Authors: Mohammed Ruzieh, Tariq Ali Ahmad, Guodong Liu, Andrew J Foy
• Journal: The American journal of the medical sciences (Am J Med Sci) Vol. 365 Issue 1 Pg. 26-30 (01 2023) ISSN: 1538-2990 [Electronic] United States
• PMID: 36096188 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors

Topics

• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (adverse effects)
• Incidence
• Selection Bias
• Diabetes Mellitus (epidemiology, etiology)