PMID- 33602950
OWN - NLM
STAT- MEDLINE
DCOM- 20211208
LR  - 20221207
IS  - 2045-2322 (Electronic)
IS  - 2045-2322 (Linking)
VI  - 11
IP  - 1
DP  - 2021 Feb 18
TI  - A nationwide cohort study for comparative vascular safety of long-acting insulin 
      analogue versus intermediate-acting human insulin in type 2 diabetes.
PG  - 4152
LID - 10.1038/s41598-021-83253-6 [doi]
LID - 4152
AB  - Little is known about the comparative vascular safety of basal insulins 
      (intermediate-acting human insulin [IAHI] or long-acting insulin analogue [LAIA]) 
      in type 2 diabetes (T2D). This study sought to examine the vascular and 
      hypoglycemic effects associated with IAHI versus LAIA in real-world patients with 
      T2D. We utilized Taiwan's National Health Insurance Research Database to identify 
      T2D patients who stably used IAHI (N = 11,521) or LAIA (N = 37,651) in the period 
      2004-2012. A rigorous three-step matching algorithm that considered the 
      initiation date of basal insulin, previous exposure of antidiabetic treatments, 
      comorbidities, diabetes severity and complications, and concomitant medications 
      was applied to achieve the between-group comparability. Study outcomes, including 
      cardiovascular diseases (CVDs), microvascular diseases (MVDs), and hypoglycemia, 
      were assessed up to the end of 2013. Compared with LAIA, the use of IAHI was 
      associated with greater risks of composite CVDs (adjusted hazard ratio [aHR]: 
      1.79; 95% confidence interval [CI] 1.20-2.67) and hospitalized hypoglycemia (aHR: 
      1.82; 95% CI 1.51-2.20), but a lower risk of composite MVDs (aHR: 0.88; 95% CI 
      0.84-0.91). Subgroup and sensitivity analyses showed a consistent trend of 
      results with that in the primary analyses. In summary, although the use of IAHI 
      versus LAIA among T2D patients in usual practice may be associated with a lower 
      risk of MVDs, strategies should be optimized for minimizing the risks of 
      hypoglycemia and CVDs in this population.
FAU - Yang, Chun-Ting
AU  - Yang CT
AD  - Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, 
      National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan.
FAU - Li, Kuan-Ying
AU  - Li KY
AD  - Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, 
      National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan.
FAU - Yang, Chen-Yi
AU  - Yang CY
AD  - Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, 
      National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan.
FAU - Ou, Huang-Tz
AU  - Ou HT
AD  - Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, 
      National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan. 
      huangtz@mail.ncku.edu.tw.
AD  - Department of Pharmacy, College of Medicine, National Cheng Kung University, 
      Tainan, Taiwan. huangtz@mail.ncku.edu.tw.
AD  - Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan. 
      huangtz@mail.ncku.edu.tw.
FAU - Kuo, Shihchen
AU  - Kuo S
AD  - Division of Metabolism, Endocrinology & Diabetes, Department of Internal 
      Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
LA  - eng
GR  - P30 DK092926/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210218
PL  - England
TA  - Sci Rep
JT  - Scientific reports
JID - 101563288
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Insulin, Long-Acting)
SB  - IM
MH  - Cardiovascular Diseases/chemically induced
MH  - Diabetes Mellitus, Type 2/*drug therapy/metabolism
MH  - Female
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Hypoglycemia/chemically induced
MH  - Insulin, Long-Acting/*adverse effects/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Retrospective Studies
PMC - PMC7893071
COIS- The authors declare no competing interests.
EDAT- 2021/02/20 06:00
MHDA- 2021/12/15 06:00
PMCR- 2021/02/18
CRDT- 2021/02/19 05:57
PHST- 2020/09/25 00:00 [received]
PHST- 2021/01/28 00:00 [accepted]
PHST- 2021/02/19 05:57 [entrez]
PHST- 2021/02/20 06:00 [pubmed]
PHST- 2021/12/15 06:00 [medline]
PHST- 2021/02/18 00:00 [pmc-release]
AID - 10.1038/s41598-021-83253-6 [pii]
AID - 83253 [pii]
AID - 10.1038/s41598-021-83253-6 [doi]
PST - epublish
SO  - Sci Rep. 2021 Feb 18;11(1):4152. doi: 10.1038/s41598-021-83253-6.