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Basal insulin raises safety concerns in T2DM patients

20 Apr 2020

Basal insulin therapy as a third antidiabetic agent appears to come with excess all-cause mortality risk in patients with type 2 diabetes mellitus (T2DM), a recent study has shown.

Researchers conducted a retrospective cohort study on 6,441 T2DM patients (mean age, 52.6±12.6 years; 63.5 percent male) receiving basal insulin, whose outcomes were compared to 49,181 recipients (mean age, 55.8±10.8 years; 56.4 percent male) of thiazolidinedione (TZD). A second comparison was done between basal insulin (n=6,148; mean age, 52.6±12.5 years; 63.4 percent male) and dipeptidylpeptidase-4 inhibitors (DPP-4is; n=82,446; mean age, 56.7±11.5 years; 57.3 percent male).

After 1:2 propensity score matching, researchers identified 36 cases of major adverse cardiovascular events (MACEs) in the basal insulin group, as opposed to 103 events in the comparator TZD patients. This did not correspond to a significant difference in risk (hazard ratio [HR], 1.24, 95 percent confidence interval [CI], 0.85–1.82).

Similarly, MACE risk did not differ between the basal insulin and DPP-4is arms (HR, 1.06, 95 percent CI, 0.73–1.54).

The same was true for hypoglycaemia, myocardial infarction and cardiovascular deaths, all of which were comparably likely to occur between basal insulin and the comparator treatment.

However, researchers found significant signals in the risk of all-cause mortality. Patients who had been given basal insulin were more likely to die from all causes relative to TZDs (HR, 0.55, 95 percent CI, 0.38–0.81) and DPP-4is (HR, 0.56, 95 percent CI, 0.39–0.82).

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Most Read Articles
5 days ago
Ivermectin confers benefits in the treatment of COVID-19, with a recent study showing that its use helps reduce the risk of death especially in patients with severe pulmonary involvement.
4 days ago
Mental health comorbidities are common among patients with type 2 diabetes mellitus and may lead to worse outcomes, a recent study has found.
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Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.

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