BACKGROUND: Statin therapy is a cornerstone of cardiovascular disease risk reduction for people with diabetes mellitus. Past reports have shown race-sex differences in statin use in general populations, but statin patterns by race and sex in those with diabetes mellitus have not been thoroughly studied. METHODS AND RESULTS: Our sample of 4288 adults ≥45 years of age with diagnosed diabetes mellitus who had low-density lipoprotein cholesterol (LDL-C) >100 mg/dL or were taking statins recruited for the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2007. Exposures included race-sex groups (white men [WM], black men [BM], white women [WW], black women [BW]) and factors that may influence healthcare utilization. Proportions and prevalence ratios were calculated for statin use and LDL-C control. Statin use for WM, BM, WW, and BW was 66.0%, 57.8%, 55.0%, and 53.6%, respectively (P<0.001). After adjustment for healthcare utilization factors, statin use was lower for BM, WW, and BW compared with WM (prevalence ratios [95%CI]: 0.96 [0.89-1.03], 0.86 [0.80-0.92], and 0.87 [0.81-0.93], respectively, P<0.001). LDL-C control among those taking statins for WM, BM, WW, and BW was 75.3%, 62.7%, 69.0%, and 56.0%, respectively (P<0.001). After adjustment, LDL-C control was lower for BM, WW, and BW compared with WM (prevalence ratios [95%CI]: 0.85 [0.79-0.93], 0.89 [0.82-0.96], and 0.73 [0.67-0.80], respectively, P<0.001). CONCLUSIONS: Race-sex disparities in statin use and LDL-C control were only partly explained by factors influencing health services utilization. Healthcare provider awareness of these disparities may help to close the observed race-sex gaps in statin use and LDL-C control among people with diabetes mellitus.