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Statin-induced necrotizing autoimmune myopathy (SINAM) is an exceptionally rare yet devastating complication of statin therapy that can occur at any time after initiation. It should be considered in patients who develop proximal muscle weakness and marked elevated creatine phosphokinase while taking statin therapy. ( Level of Difficulty: Beginner. )

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Sepsis is one of the leading causes of ICU mortality, and diabetes is a significant risk factor for the development of infections. Hyperglycemia has been associated with altered immune function and increased severity of infections. A growing amount of evidence suggests an association between pre-admission metformin use and decreased rates of sepsis and inpatient mortality. However, the risk of developing infections among patients with type 2 diabetes taking newer classes of oral anti-diabetic drugs (OADs) is uncertain. The aim of our study is to examine the association between outpatient OAD use and hospital admissions for infections. METHODS: This is a national retrospective data analysis utilizing the Veterans Health Affairs Corporate Data Warehouse. We identified patients 18 years old and older with diabetes who filled at least 1 OAD prescription in calendar years 2013-2017. Patients were classified as taking metformin, sulfonylureas, alpha-glucosidase inhibitors, meglitinides, thiazolidinediones, DPP4 inhibitors, or SGLT2 inhibitors at any point during the five-year study period regardless of admission date. The endpoint was defined as a hospital admission with an infectious condition on the admission or discharge diagnosis list. Multivariate logistic regression was used to estimate the effect of each drug class on admission while adjusting for age, sex, race, smoking status, and Elixhauser Comorbidity Index.