Background: Statins have been recommended by contemporary guidelines to be used in all diabetic patients regardless of the baseline cholesterol; more real-world data are needed to know about the actual pattern of statin use. We aimed to determine the pattern of statin use in the diabetic population in Almadinah Almunawwarah, Saudi Arabia. Results: This was a cross-sectional study on 167 Saudi adult diabetic patients attending the outpatient diabetes clinic through interviewing the patients and filling-in a questionnaire. Multivariate binary logistic analysis was used to assess the predictors of poor adherence to statin. Statins were prescribed to 122 (73.1%) patients. There were 109 (65.3%) patients who were aged 40 years or above and had no cardiovascular disease (CVD), of those, 70.6% were receiving statins for primary prevention. Whilst, CVD was diagnosed in 44 (26.3%) patients, of those, 97.7% were receiving statins for secondary prevention. After adjustment of confounders, there was a significant association (p<0.05) between low adherence to statin and three predictors; diabetes duration ≥ 15 years, OR=5.09, (95% CI: 2.06-12.59), age range (45- 54.9 years), OR=4.66, (95% CI: 1.63-13.36), and polypharmacy of ≥ 5 drugs, OR=3.44, (95% CI: 5.09-7.93). Conclusions: Even though the rate of statin prescription in our study was higher than the world-wide numbers, it is far below the clinical guidelines recommendations. Efforts are needed to improve adherence to the updated guidelines to use statin for all diabetic patients above the age of 40 years to prevent CVD. Moreover, cost-effectiveness studies are needed to evaluate the impact of using statins in all diabetic patients

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