Statins are the cornerstone of LDL-C reduction in Type 2 diabetes (T2D) for both primary and secondary cardiovascular prevention. Adherence is frequently limited by adverse effects, most notably statin-associated muscle symptoms (SAMS), which affect 5–10% of users in previous studies. The SAMS Clinical Index (SAMS-CI) is a valuable tool for detecting muscle symptoms for people who are taking statin. This interim analysis from the Prospective Multi-ethnic Lifestyle, Obesity and Diabetes registry in MalaYsia (MeLODY) cohort examined the prevalence and characteristics of SAMS among Malaysian adults with T2D.

Adults with T2D recruited under the MeLODY Cohort since July 2025 were included (n=90). Participants were enrolled across primary care clinics, specialist clinic and tertiary academic medical centre, representing all levels of diabetes care in Malaysia. Twelve not on statins or non-adherent (not related to SAMS) were excluded, leaving 78 for analysis. SAMS-CI score classifies SAMS as: <7 (Unlikely), 7-8 (Possible), and 9-11 (Probable). All statistical analysis was carried out using SPSS v.30.

The mean age was 63.56 ± 9.34 years; 65.4% were male with mean BMI of 27.0 ± 4.8 kg/m^2, HbA1c (NGSP) 8.36% and median LDL 2.0 mmol/L (1.70-3.08). Ethnic distribution was 29.5% Malay, 46.2% Chinese, 21.8% Indian. Mean duration of diabetes was 13.6 years, with mean age at diagnosis 48.6 ± 11.4 years. 51% participants follow-up diabetes under primary care setting. Most participants were on statin monotherapy (89.7%), with 9.0% on statin + ezetimibe and 1.3% on siRNA + statin. High-intensity statins were prescribed in 57.9% and moderate-intensity in 36.8%, with atorvastatin used in 69.7%. 21 participants reported having muscle symptoms, however 18/21 were unable to complete SAMS-CI scoring as there were no attempts to withdraw statin therapy (self-withdrawal or physician-mediated), a requirement to answer 2 out of 4 questions of SAMS-CI. Due to incomplete scoring, the prevalence of possible/probable SAMS in the cohort is likely under-reported at 5.1%, observed only among those on moderate- to high-intensity atorvastatin.

The prevalence of possible/probable SAMS in this cohort likely under-reported due to incomplete SAMS-CI assessment. Greater physician awareness and systematic use of SAMS-CI, including consideration of temporary statin withdrawal when appropriate, are needed to improve detection. Further studies, including qualitative research, are warranted to explore barriers to recognition and management of SAMS in routine diabetes care.