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Mortality Rates in Type 2 Patients Exposed to Glargine

Jul 31, 2015

Impact of long-term use of medication on cardiovascular events studied…

There are several studies that state that diabetes decreases life expectancy due to an increase of cardiovascular events and there is inclusive evidence about utilizing tight glycemic control to decrease the risk of these events. Many diabetics utilize insulin glargine as a maintenance insulin for glycemic control; however, there is not a lot of information concerning the use of glargine long term and the effects on cardiovascular mortality.

The purpose of a current study is to evaluate the outcomes of insulin glargine on cardiovascular mortality in patients with type 2 diabetes. The study consisted of 79,869 participants who were 40 years old or older. The participants were screened from 2001 to 2008. Baseline characteristics was defined 6 months after the start of insulin glargine. All the participants received follow up until December 31, 2011. The primary outcome of the study was cardiovascular mortality defined by ICD-10 codes I00-I99. Secondary outcomes were myocardial infarction and fatal strokes. The data was analyzed using a parametric test. The time-dependent variables were time and dose exposure to various diabetes therapy. The variables were used to assess glargine impact on cardiovascular mortality rates.

The results showed that glargine time exposure significantly decreased overall cardiovascular, subhazard ratio (SHR) 0.963 (CI 95% 0.944–0.981, p < 0.001), and myocardial infarction mortality, SHR 0.945 (CI 95% 0.899–0.994, p = 0.028), but not stroke mortality. Glargine dose exposure (10,000 IU increments) significantly reduced cardiovascular mortality, SHR 0.977 (CI 95% 0.960–0.993, p = 0.006), but not myocardial infarction and stroke.

To conclude, dose and time exposure to glargine were related to decreased cardiovascular mortality.

Practice Pearls:

  • Long-term exposure to glargine is safe in patients with type 2 diabetes.
  • Dose and cumulative time exposure to glargine can lower the risk of cardiovascular events.
  • Basal insulin should be recommend for glycemic control due to in long-standing safety profile.

Ioacara S, Guja C, Reghina A, Martin S, Sirbu A, Fica S. “Cardiovascular Mortality in Type 2 Diabetes Patients with Incident Exposure to Insulin Glargine.” J Diabetes Res. 2015;2015:962346.