The association of long-acting insulin analogue use versus neutral protamine Hagedorn insulin use and the risk of major adverse cardiovascular events among individuals with type 2 diabetes: A population-based cohort study.
Brain Ischemia
Cohort Studies
Diabetes Mellitus, Type 2
/ complications
Humans
Hypoglycemic Agents
/ adverse effects
Insulin
/ adverse effects
Insulin Glargine
/ therapeutic use
Insulin, Isophane
/ adverse effects
Insulin, Long-Acting
/ therapeutic use
Protamines
/ therapeutic use
Retrospective Studies
Stroke
/ chemically induced
cohort study
insulin analogues
pharmaco-epidemiology
type 2 diabetes
Journal
Diabetes, obesity & metabolism
ISSN: 1463-1326
Titre abrégé: Diabetes Obes Metab
Pays: England
ID NLM: 100883645
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
revised:
08
06
2022
received:
21
03
2022
accepted:
16
06
2022
pubmed:
22
6
2022
medline:
5
10
2022
entrez:
21
6
2022
Statut:
ppublish
Résumé
To compare the risk of cardiovascular outcomes associated with long-acting insulin analogues versus neutral protamine Hagedorn (NPH) insulin among patients with type 2 diabetes. We conducted a population-based retrospective cohort study using the UK Clinical Practice Research Datalink Aurum, linked with hospitalization and vital statistics data. Patients with type 2 diabetes who initiated basal insulin treatment between 2002 and 2018 were included in the study. Exposure was defined as current use of long-acting insulin analogues or NPH insulin, defined using a time-varying approach. The primary outcome was major adverse cardiovascular events (MACE; a composite endpoint of myocardial infarction, ischaemic stroke and cardiovascular death). We used a marginal structural Cox proportional hazards model to estimate the hazard ratio (HR) and 95% confidence interval (CI) for MACE with current use of long-acting insulin analogues versus NPH insulin, and in secondary analyses, by long-acting insulin molecule. Our cohort included 57 334 patients. A total of 3494 MACE occurred over a mean follow-up of 1.6 years (incidence rate 37.4, 95% CI 36.2 to 38.7 per 1000 person-years). Long-acting insulin analogues were associated with a decreased risk of MACE compared to NPH insulin (HR 0.89, 95% CI 0.83 to 0.96). Current use of long-acting insulin analogues is associated with a modestly reduced risk of MACE compared to current use of NPH insulin among patients with type 2 diabetes. This study could have important implications for drug plan managers and guideline-writing committees for recommendations of insulin treatment for type 2 diabetes.
Substances chimiques
Hypoglycemic Agents
0
Insulin
0
Insulin, Long-Acting
0
Protamines
0
Insulin Glargine
2ZM8CX04RZ
Insulin, Isophane
53027-39-7
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2169-2181Subventions
Organisme : CIHR
ID : PJT-175280
Pays : Canada
Informations de copyright
© 2022 John Wiley & Sons Ltd.
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