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The Association of Long-Acting Insulin Analogue Use Versus Neutral Protamine Hagedorn Insulin Use With Major Adverse Cardiovascular Events Among Individuals With Type 2 Diabetes: A Population-Based Cohort Study

Diabetes Obes Metab. 2022 Jun 21. doi: 10.1111/dom.14802. Online ahead of print.


AIMS: To compare the risk of cardiovascular outcomes with long-acting insulin analogues versus Neutral Protamine Hagedorn (NPH) insulin among patients with type 2 diabetes.

MATERIALS AND METHODS: We conducted a population-based retrospective cohort study, using the United Kingdom Clinical Practice Research Datalink Aurum, linked with hospitalization and vital statistics data. Patients with type 2 diabetes who initiated basal insulin treatment between 2002-2018 were included in the study. Exposure was defined as current use of long-acting insulin analogues or NPH insulin, defined using a time-varying approach. The primary outcome was major adverse cardiovascular events (MACE, composite endpoint of myocardial infarction [MI], ischemic stroke, and cardiovascular death). We used a marginal structural Cox proportional hazards model to estimate the hazard ratio (HR) and 95% confidence interval (CI) for MACE with current use of long-acting insulin analogues versus NPH insulin, and by long-acting insulin molecule in secondary analyses.

RESULTS: Our cohort included 57 334 patients. A total of 3494 MACE events occurred over a mean follow-up of 1.6 years (incidence rate: 37.4, 95% CI: 36.2 to 38.7 per 1000 person-years). Long-acting insulin analogues were associated with a decreased risk of MACE compared to NPH insulin (HR: 0.89, 95% CI: 0.83 to 0.96).

CONCLUSIONS: Current use of long-acting insulin analogues is associated with a modestly reduced risk of MACE compared to current use of NPH insulin among patients with type 2 diabetes. This study can have important implications for drug plan managers and guideline writing committees for recommendations of insulin treatment for type 2 diabetes. This article is protected by copyright. All rights reserved.

PMID:35726454 | DOI:10.1111/dom.14802

By Nevin Manimala

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