Human vs analog insulin for T2D: no difference in CV events, mortality

  • Neugebauer R & al.
  • JAMA Netw Open
  • 3 Jan 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Adults with type 2 diabetes (T2D) who are newly prescribed either human insulin (HI) or analog insulin (AI) had similar rates of overall and cardiovascular (CV) mortality and major CV events during 2.5 years of follow-up.
  • Other relevant factors to consider include hypoglycemia, glycemic control, cost, and ease of use.

Why this matters

  • AI is far more expensive than HI, yet few studies have compared CV outcomes between the two.

Study design

  • Retrospective cohort study of 127,600 adults ages 21-89 years with T2D who initiated insulin in 4 health care delivery systems during 2000-2013.
  • Funding: NIH.

Key results

  • No differences between AI and HI in change in HbA1c during 2.5-year follow-up.
  • Overall outcome rates were 4.3% deaths, 1.4% myocardial infarctions (MIs), 1.0% cerebrovascular accidents (CVAs), and 2.4% congestive heart failure (CHF) hospitalizations.
  • Adjusted HRs and 95% CIs for continuous AI vs HI exposure showed no statistically significant associations with:
    • Overall mortality: 1.15 (0.97-1.34);
    • CV disease mortality: 1.26 (0.86-1.66); 
    • MI: 1.11 (0.77-1.45);
    • CVA: 1.30 (0.81-1.78); or 
    • CHF hospitalization: 0.93 (0.75-1.11).

Limitations

  • Cohort study design.
  • Wide variation in insulin-type choice across sites because of formulary preferences.
  • Short- and long-acting insulins considered together.