Comparison of basal insulin therapies with regard to the risk of acute myocardial infarction in patients with type 2 diabetes: an observational cohort study

• Published in: Diabetes, obesity & metabolism obesity & metabolism, 2015-12, Vol.17 (12), p.1158-1165
• Main Authors: Kollhorst, B., Behr, S., Enders, D., Dippel, F.-W., Theobald, K., Garbe, E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; basal insulin; Cohort Studies; Comorbidity; Diabetes; diabetes complications; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetic Angiopathies - chemically induced; Diabetic Angiopathies - epidemiology; Diabetic Angiopathies - prevention & control; Diabetic Cardiomyopathies - chemically induced; Diabetic Cardiomyopathies - epidemiology; Diabetic Cardiomyopathies - prevention & control; Drug Prescriptions; Female; Germany - epidemiology; Heart attacks; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Incidence; Insulin; Insulin - adverse effects; Insulin - therapeutic use; insulin therapy; Insurance, Health; Male; Middle Aged; Myocardial infarction; Myocardial Infarction - chemically induced; Myocardial Infarction - complications; Myocardial Infarction - epidemiology; Myocardial Infarction - prevention & control; observational study; Proportional Hazards Models; Retrospective Studies; Risk; Sensitivity analysis; Statistical analysis; type 2 diabetes
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.12554

Aims To assess the risk of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus treated with long‐acting insulin analogues in comparison with other basal insulin therapy. Methods We used German insurance claims data from the years 2004–2009 to conduct a study in a retrospective cohort of patients with type 2 diabetes. Naïve insulin users were defined as patients who had an insulin‐free history before the first prescription of long‐acting analogue insulin, human NPH insulin or premixed insulin and who were pretreated with oral antidiabetic drugs. Adjusted hazard ratios (HRs) of AMI and corresponding 95% confidence intervals (CIs) were calculated using sex‐stratified Cox models. Propensity‐score‐matched analyses were conducted as sensitivity analyses. Results We identified 21 501 new insulin users. Patients treated with premixed insulin were older than patients treated with analogue or NPH insulin (mean age 70.7 vs. 64.1 and 61.6 years, respectively) and had more comorbidities. Regarding the risk of AMI, adjusted HRs showed no statistically significant difference between NPH and analogue insulin (HR 0.94, 95% CI 0.74–1.19), but a higher risk for premixed than for analogue insulin (HR 1.27, 95% CI 1.02–1.58). Contrary to the primary analysis, the propensity‐score‐matched analysis did not show an increased risk for premixed insulin. Conclusions In contrast to a former database study, no difference was observed for the risk of AMI between long‐acting analogue and NPH insulin in this study. Neither long‐acting analogue insulin nor premixed insulin appears to be associated with AMI in patients with type 2 diabetes.