Abstract 39: Statin Use is Associated with Elevated Serum Glucose and Incidence of Type 2 Diabetes in US Veterans

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Background: While some but not all trial data have suggested a slightly elevated risk of type 2 diabetes (T2D), limited data are available on the relation of statin use with glycemia among US veterans. Objective: To test the hypothesis that treatment with a statin is associated with elevated serum glucose and a higher risk of T2D among US veterans. Methods: We studied 549,143 US veterans with electronic health records from 1998 to 2016. We used the VA Corporate Data Warehouse to obtain information on glucose (fasting and non-fasting). Statin use was captured using the pharmacy database. T2D was defined as having at least one inpatient diagnosis or at least 2 outpatient diagnoses of T2D using ICD 9 codes 250.xx, or the use of hypoglycemic agents. We addressed confounding by indication using propensity score (included 444 variables/interactions) for receiving statin and inverse probability weighting in the Cox regression. Results: The mean age was 60±12.8 y; 94.3% were men; 77.1% were white; and 15.4% were black. In this cohort, simvastatin was the most prescribed statin (84%) followed by lovastatin (7%). During a median follow-up of 4.4 years, 130,819 new cases of T2D occurred. Among 418,847 veterans receiving statin, we observed a 2 mg/dl increase in serum glucose when comparing serum glucose measured at the time of statin initiation and short-term <1 y as well as long-term glucose values (all p <0.01). In crude analysis, statin use was associated with a 53% higher risk of T2D compared with non-users of statin [HR=1.53 (95% CI: 1.51-1.54)]. In a multivariable adjusted model, hazard ratio (95% CI) for T2D was 1.25 (95% CI: 1.24-1.26) after adjustment for propensity score for being on statin. There was a borderline statistically significant interaction between statin and triglycerides on T2D risk (p=0.09): HR=1.15 (95% CI: 1.14-1.16) for people with triglecerides below 150 mg/dl and HR=1.36 (95% CI: 1.35-1.38) for people with triglycerides of at least 150 mg/dl in the adjusted model. We did not have enough data to stratify by type of statin given the predominance of simvastatin in this population. Conclusions: Our data show a positive association between statin use and increase in both serum glucose and incidence of T2D among US veterans. If confirmed by others, this suggests closer monitoring of patients at risk of T2D when statin therapy is initiated.