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Comparison of Mortality and Major Cardiovascular Events Among Adults With Type 2 Diabetes Using Human vs Analogue Insulins.
Neugebauer, Romain; Schroeder, Emily B; Reynolds, Kristi; Schmittdiel, Julie A; Loes, Linda; Dyer, Wendy; Desai, Jay R; Vazquez-Benitez, Gabriela; Ho, P Michael; Anderson, Jeff P; Pimentel, Noel; O'Connor, Patrick J.
Affiliation
  • Neugebauer R; Division of Research, Kaiser Permanente Northern California, Oakland.
  • Schroeder EB; Kaiser Permanente Colorado Institute for Health Research, Aurora.
  • Reynolds K; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
  • Schmittdiel JA; Division of Research, Kaiser Permanente Northern California, Oakland.
  • Loes L; HealthPartners Institute, Minneapolis, Minnesota.
  • Dyer W; Division of Research, Kaiser Permanente Northern California, Oakland.
  • Desai JR; HealthPartners Institute, Minneapolis, Minnesota.
  • Vazquez-Benitez G; HealthPartners Institute, Minneapolis, Minnesota.
  • Ho PM; Rocky Mountain Regional Veterans Affairs and University of Colorado (Anschutz) Medical Center, Denver.
  • Anderson JP; HealthPartners Institute, Minneapolis, Minnesota.
  • Pimentel N; Division of Research, Kaiser Permanente Northern California, Oakland.
  • O'Connor PJ; HealthPartners Institute, Minneapolis, Minnesota.
JAMA Netw Open ; 3(1): e1918554, 2020 01 03.
Article in En | MEDLINE | ID: mdl-31977057
ABSTRACT
Importance The comparative cardiovascular safety of analogue and human insulins in adults with type 2 diabetes who initiate insulin therapy in usual care settings has not been carefully evaluated using machine learning and other rigorous analytic methods.

Objective:

To examine the association of analogue vs human insulin use with mortality and major cardiovascular events. Design, Setting, and

Participants:

This retrospective cohort study included 127 600 adults aged 21 to 89 years with type 2 diabetes at 4 health care delivery systems who initiated insulin therapy from January 1, 2000, through December 31, 2013. Machine learning and rigorous inference methods with time-varying exposures were used to evaluate associations of continuous exposure to analogue vs human insulins with mortality and major cardiovascular events. Data were analyzed from September 1, 2017, through June 30, 2018. Exposures On the index date (first insulin dispensing), participants were classified as using analogue insulin with or without human insulin or human insulin only. Main Outcomes and

Measures:

Overall mortality, mortality due to cardiovascular disease (CVD), myocardial infarction (MI), stroke or cerebrovascular accident (CVA), and hospitalization for congestive heart failure (CHF) were evaluated. Marginal structural modeling (MSM) with inverse probability weighting was used to compare event-free survival in separate per-protocol analyses. Adjusted and unadjusted hazard ratios and cumulative risk differences were based on logistic MSM parameterizations for counterfactual hazards. Propensity scores were estimated using a data-adaptive approach (machine learning) based on 3 nested covariate adjustment sets. Sensitivity analyses were conducted to address potential residual confounding from unmeasured differences in risk factors across delivery systems.

Results:

The 127 600 participants (mean [SD] age, 59.4 [12.6] years; 68 588 men [53.8%]; mean [SD] body mass index, 32.3 [7.1]) had a median follow-up of 4 quarters (interquartile range, 3-9 quarters) and experienced 5464 deaths overall (4.3%), 1729 MIs (1.4%), 1301 CVAs (1.0%), and 3082 CHF hospitalizations (2.4%). There were no differences in adjusted hazard ratios for continuous analogue vs human insulin exposure during 10 quarters for overall mortality (1.15; 95% CI, 0.97-1.34), CVD mortality (1.26; 95% CI, 0.86-1.66), MI (1.11; 95% CI, 0.77-1.45), CVA (1.30; 95% CI, 0.81-1.78), or CHF hospitalization (0.93; 95% CI, 0.75-1.11). Conclusions and Relevance Insulin-naive adults with type 2 diabetes who initiate and continue treatment with human vs analogue insulins had similar observed rates of major cardiovascular events, CVD mortality, and overall mortality.
Subject(s)

Full text: 1 Database: MEDLINE Main subject: Cardiovascular Diseases / Diabetes Mellitus, Type 2 / Diabetic Cardiomyopathies / Insulin, Regular, Human / Hypoglycemic Agents / Insulin Type of study: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Language: En Year: 2020 Type: Article

Full text: 1 Database: MEDLINE Main subject: Cardiovascular Diseases / Diabetes Mellitus, Type 2 / Diabetic Cardiomyopathies / Insulin, Regular, Human / Hypoglycemic Agents / Insulin Type of study: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Language: En Year: 2020 Type: Article