Data on statin therapy intensity and icosapent ethyl use among adults with diabetes mellitus (DM) are limited. We studied statin intensity and icosapent ethyl use with lipid levels among US adults with DM across risk groups, sex and ethnicity.

Among adults ≥18 years of age with DM from the NIH Precision Medicine Initiative All of Us Study, we categorized risk groups as 1) low risk with ≤1 DM risk factor, 2) high risk with ≥2 DM risk factors, and 3) DM with known ASCVD. Risk factors included age >60 years, hypertension, LDL-C ≥160 mg/dL, cigarette smoking, and HDL-C <40 mg/dL (males) and <50 mg/dL (females). We examined the % of people on low, moderate, and high-intensity statin therapy and at LDL-C levels <70 mg/dL, 70-99 mg/dL, and ≥100 mg/dL. We also studied the % of people on icosapent ethyl and examined triglyceride (TG) levels <100 mg/dL, 100-149 mg/dL, and ≥150 mg/dL.

Our 42,064 participants with DM included 27.1% non-Hispanic black and 21.7% Hispanic. Inadequate statin use and improperly controlled LDL-C remain common, with 33.8% of people on high-intensity statins having LDL-C levels ≥100 mg/dL. Additionally, 1.7% of those with TG levels ≥150 mg/dL were on icosapent ethyl.

Guideline-recommended use of high intensity statins among our higher risk DM patients is lacking, with many having inadequately controlled LDL-C levels. Moreover, icosapent ethyl use remains low, even among those with high TG levels. Further provider and patient education need to be prioritized— especially among those at highest risk.