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Lower incidence of recorded cardiovascular outcomes in patients with type 2 diabetes using insulin aspart vs. those on human regular insulin: observational evidence from general practices.
Diabetes Obes Metab. 2013 Apr; 15(4):358-63.DO

Abstract

AIMS

Insulin aspart has a higher ability to treat postprandial glucose than regular human insulin, which may have favourable cardiovascular effects. The aim was to collect and compare the incidence of recorded macro- and microvascular events in patients with type 2 diabetes with insulin aspart or regular human insulin in general practices.

METHODS

Computerized data from 3154 aspart and 3154 regular insulin users throughout Germany (Disease Analyzer, January 2000 to July 2011) were analysed after matching for age (60 ± 10 years), sex (men: 57%), health insurance (private: 5.8%) and diabetes treatment period in practice (2.2 ± 2.5 years). Hazard ratios (HR; Cox regression) for macro- or microvascular outcomes (follow-up: 3.5 years) were further adjusted for diabetologist care, practice region, hypertension, hyperlipidaemia, co-medication (basal insulin, oral antidiabetics, antihypertensives, lipid-lowering agents and antithrombotic drugs), previous treatment with rapid-acting insulins, hypoglycaemia and the Charlson co-morbidity score. Furthermore, adjustment was carried out for baseline microvascular complications when analysing macrovascular outcomes and vice versa.

RESULTS

Overall, the risk of combined macrovascular outcomes was 15% lower for insulin aspart users (p = 0.01). For insulin aspart there was also a decreased risk incident stroke [HR: 0.58; 95% confidence interval (CI): 0.45-0.74], myocardial infarction (HR: 0.69; 95% CI: 0.54-0.88) and peripheral vascular disease (HR: 0.80; 95% CI: 0.69-0.93). For microvascular complications (retinopathy, neuropathy and nephropathy), no significant differences were observed (HR: 0.96; 95% CI: 0.87-1.06).

CONCLUSION

Use of the rapid-acting insulin analogue aspart was associated with a reduced incidence of macrovascular outcomes in type 2 diabetes in general practices. It is important to confirm this finding in a randomized controlled trial.

Authors+Show Affiliations

German Diabetes Center, Institute of Biometrics and Epidemiology, Düsseldorf, Germany. rathmann@ddz.uni-duesseldorf.deNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23137345

Citation

Rathmann, W, and K Kostev. "Lower Incidence of Recorded Cardiovascular Outcomes in Patients With Type 2 Diabetes Using Insulin Aspart Vs. Those On Human Regular Insulin: Observational Evidence From General Practices." Diabetes, Obesity & Metabolism, vol. 15, no. 4, 2013, pp. 358-63.
Rathmann W, Kostev K. Lower incidence of recorded cardiovascular outcomes in patients with type 2 diabetes using insulin aspart vs. those on human regular insulin: observational evidence from general practices. Diabetes Obes Metab. 2013;15(4):358-63.
Rathmann, W., & Kostev, K. (2013). Lower incidence of recorded cardiovascular outcomes in patients with type 2 diabetes using insulin aspart vs. those on human regular insulin: observational evidence from general practices. Diabetes, Obesity & Metabolism, 15(4), 358-63. https://doi.org/10.1111/dom.12035
Rathmann W, Kostev K. Lower Incidence of Recorded Cardiovascular Outcomes in Patients With Type 2 Diabetes Using Insulin Aspart Vs. Those On Human Regular Insulin: Observational Evidence From General Practices. Diabetes Obes Metab. 2013;15(4):358-63. PubMed PMID: 23137345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lower incidence of recorded cardiovascular outcomes in patients with type 2 diabetes using insulin aspart vs. those on human regular insulin: observational evidence from general practices. AU - Rathmann,W, AU - Kostev,K, Y1 - 2012/11/28/ PY - 2012/08/02/received PY - 2012/09/06/revised PY - 2012/11/02/accepted PY - 2012/11/10/entrez PY - 2012/11/10/pubmed PY - 2013/10/1/medline SP - 358 EP - 63 JF - Diabetes, obesity & metabolism JO - Diabetes Obes Metab VL - 15 IS - 4 N2 - AIMS: Insulin aspart has a higher ability to treat postprandial glucose than regular human insulin, which may have favourable cardiovascular effects. The aim was to collect and compare the incidence of recorded macro- and microvascular events in patients with type 2 diabetes with insulin aspart or regular human insulin in general practices. METHODS: Computerized data from 3154 aspart and 3154 regular insulin users throughout Germany (Disease Analyzer, January 2000 to July 2011) were analysed after matching for age (60 ± 10 years), sex (men: 57%), health insurance (private: 5.8%) and diabetes treatment period in practice (2.2 ± 2.5 years). Hazard ratios (HR; Cox regression) for macro- or microvascular outcomes (follow-up: 3.5 years) were further adjusted for diabetologist care, practice region, hypertension, hyperlipidaemia, co-medication (basal insulin, oral antidiabetics, antihypertensives, lipid-lowering agents and antithrombotic drugs), previous treatment with rapid-acting insulins, hypoglycaemia and the Charlson co-morbidity score. Furthermore, adjustment was carried out for baseline microvascular complications when analysing macrovascular outcomes and vice versa. RESULTS: Overall, the risk of combined macrovascular outcomes was 15% lower for insulin aspart users (p = 0.01). For insulin aspart there was also a decreased risk incident stroke [HR: 0.58; 95% confidence interval (CI): 0.45-0.74], myocardial infarction (HR: 0.69; 95% CI: 0.54-0.88) and peripheral vascular disease (HR: 0.80; 95% CI: 0.69-0.93). For microvascular complications (retinopathy, neuropathy and nephropathy), no significant differences were observed (HR: 0.96; 95% CI: 0.87-1.06). CONCLUSION: Use of the rapid-acting insulin analogue aspart was associated with a reduced incidence of macrovascular outcomes in type 2 diabetes in general practices. It is important to confirm this finding in a randomized controlled trial. SN - 1463-1326 UR - https://www.unboundmedicine.com/medline/citation/23137345/Lower_incidence_of_recorded_cardiovascular_outcomes_in_patients_with_type_2_diabetes_using_insulin_aspart_vs__those_on_human_regular_insulin:_observational_evidence_from_general_practices_ L2 - https://doi.org/10.1111/dom.12035 DB - PRIME DP - Unbound Medicine ER -