OBJECTIVES:  This study evaluates new onset diabetes and related outcome variables over a 24 month period in pre-diabetic patients taking a statin medication. METHODS:  A United States retrospective medical chart review of 1000 randomly selected pre-diabetic adult patients, among 5 Accountable Care Organizations (ACOs) (200 per site), was conducted. Patients were taking one of the following statins: Rosuvastatin, Atorvastatin, Simvastatin and Pitavastatin, for 12 months prior to the start of the study. Patients also had documentation of at least one of the following to confirm pre-diabetic status: metabolic syndrome, fasting blood glucose of >100 mmol/L, A1c of >6%, or BMI >30 kg/m2. Patient characteristics were collected over 24 months (April 1, 2014 – April 1, 2016). RESULTS:  The sample was 51% male, and 49% white, with a mean age of 62.3 ± 12.3 years. Of the 1000 patients initiated into the study, 146 were lost to follow up. The final cohort consisted of 854 patients with 24 months of data. BMI (p=0.033) and weight (p=0.0016) values were significantly higher among Rosuvastatin patients while fasting blood glucose levels were significantly higher among Simvastatin patients (p=0.0001. A total of 61 (7.1%) patients had a diagnosis of diabetes by the end of the study period. Most of these patients (42.6%) were taking Simvastatin before diagnosis of diabetes, and only 9 (14.7%) patients discontinued statin use, changed statin dose, or switched to a different statin after their diagnosis. CONCLUSIONS:  In this real-world retrospective observational study, only 61 pre-diabetic patients taking a statin for at least 12 months prior to the start of the study ended up with a diagnosis of diabetes. With recent concerns regarding the link between statin use and diabetes risk, this study suggests that further research into the relationship between diabetes and statin use is necessary to improve patient health management and outcomes.