Incidence rates of heart failure, stroke, and acute myocardial infarction among Type 2 diabetic patients using insulin glargine and other insulin

• Published in: Pharmacoepidemiology and drug safety 2009-06, Vol.18 (6), p.497-503
• Main Authors: Juhaeri, Juhaeri, Gao, Shujun, Dai, Wanju S.
• Format: Article
• Language: English
• Subjects: Acute Disease; acute myocardial infarction; Adult; Aged; Aged, 80 and over; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - epidemiology; Cohort Studies; Diabetes Mellitus, Type 2 - drug therapy; epidemiology; Female; heart failure; Heart Failure - chemically induced; Heart Failure - epidemiology; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Incidence; Insulin - adverse effects; Insulin - analogs & derivatives; Insulin - therapeutic use; Insulin Glargine; Insulin, Isophane - adverse effects; Insulin, Isophane - therapeutic use; Insulin, Long-Acting - adverse effects; Insulin, Long-Acting - therapeutic use; Male; Middle Aged; Myocardial Infarction - chemically induced; Myocardial Infarction - epidemiology; Retrospective Studies; stroke; Stroke - chemically induced; Stroke - epidemiology
• ISSN: 1053-8569; 1099-1557
• DOI: 10.1002/pds.1741

Purpose The aim of this study was to compare incidence rates of heart failure, stroke, and acute myocardial infarction (AMI) in Type 2 diabetic patients using different types of insulin. Methods Included were patients with a diagnosis of Type 2 diabetes and at least one insulin prescription from May 2001 to July 2007. Incidence rate ratios (RRs) of heart failure, stroke, and AMI were estimated using Poisson regression with adjustment for age, gender, history of hypertension, dyslipidemia history, days supply, and duration of diabetes. Results Incidence rates of heart failure, stroke, and AMI in the insulin glargine group were 306.9 (95%CI: [278.9, 334.8]), 174.8 (95%CI: [153.7, 195.8]), and 105.2 (95%CI: [88.9, 121.5]) cases per 10 000 person–years, respectively. After adjustment for covariates, the incidence rates of CVD events in the insulin glargine were comparable to those in the other long/intermediate acting insulin group (reference), except for AMI, which tended to be lower in the insulin glargine group (RR = 0.81, 95%CI: [0.65, 1.02]). Using the same reference, the incidence rate of stroke was higher in patients taking rapid/short acting insulin, premixed insulin, or mixed use of insulin except insulin glargine (RR = 1.20, 95%CI: [1.04, 1.40]). Conclusion This study suggested that insulin glargine use might be associated with a lower risk of AMI, compared to the other long/intermediate acting insulin use, and that insulin regimen of rapid/short acting insulin, premixed insulin, or mixed use of insulin except insulin glargine was associated with a higher risk of stroke using the same reference. Copyright © 2009 John Wiley & Sons, Ltd.