Background There is evidence of statin benefit among patients with diabetes regardless of their cholesterol levels or prior cardiovascular disease history. Despite the evidence, there is under-prescription of statins in clinical practice. This study aimed to assess statin prescriptions and associated factors among patients with type 2 diabetes in Botswana.

Methods The study was a secondary data analysis of 500 randomly selected type 2 diabetes patients at a specialised diabetes clinic at Gaborone Botswana. We assessed the proportion of statin-eligible patients who were prescribed statins and evaluated the adjusted associations between various factors and statin prescription.

Results Overall, 477(95.4%) participants were eligible for a statin prescription. Clinicians prescribed statins in 217(45.5%%; 95% confidence interval[CI]: 41.1%-50.0%) of eligible participants, and only one(4.4%) ineligible participant. The probability of statin prescription was high in participants with high baseline low-density lipoprotein cholesterol(risk ratio [RR]:1.49; 95%CI: 1.17 - 1.89), increasing duration of diabetes (RR: 1.01; 95%CI 1.00 - 1.03) and the presence of chronic kidney disease (RR: 1.35; 95%CI: 1.06 - 1.74). Conclusion Most patients with type 2 diabetes were not receiving statins. Clinicians did not consider most guideline-recommended indications for statin prescription. The findings call for improvement in diabetes quality of care by implementing evidence-based guideline recommendations

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