Issue 171 Item 1 Heart Failure Incidence Increased in Insulin-Treated Type 2 Dia

Dr. Gregory Nichols, with the Center for Health Research in Portland, Oregon, United States, and colleagues, estimated the incidence rates of CHF in subjects newly initiating various anti-hyperglycaemic therapeutic regimens, adjusted for age, gender, duration of diabetes, glycemic control, and presence of ischemic heart disease.

He reported the study’s findings August 29th at the Eighteenth International Diabetes Federation (IDF) Congress.

The study, performed at a health maintenance organization, included patients who had type 2 diabetes diagnosed prior to January 1, 1998, and did not have pre-existing CHF. Subjects who did not maintain their index therapy for at least 90 days without experiencing CHF were excluded.

Initial therapy was defined as the anti-hyperglycemic therapy observed as of January 1, 1998. Index therapy was defined as a change (switch or addition of drug) from the initial therapy; the date of the change was defined as the index date.

Subjects were followed from their index date until they were diagnosed with CHF, changed their index therapy, left the health plan, or until December 31, 2003.

Overall, there were 195 incident cases of CHF in 4,356 patients who initiated a new therapy over a mean follow-up of 22 months, which amounts to an unadjusted incident rate of 2.50 cases per 100 person-years, Dr. Nichols reported.

After controlling for CHF risk factors, patients starting insulin monotherapy were significantly more likely to develop CHF compared to patients treated with sulphonylurea monotherapy (RR=1.68, p=.010) or metformin monotherapy (RR=2.10, p=.022).

Further analysis revealed that patients on triple therapy were twice as likely to develop CHF compared to patients initiating sulphonylurea/metformin combination therapy (RR=2.00, p=.009).

"The data indicate an increased risk of CHF associated with the use of exogenous insulin, even after adjusting other known CHF risk factors including age an ischaemic heart disease," Dr. Nichols said. "The findings," he added, "are consistent with the theory that elevated insulin levels, whether endogenous or exogenous, promote the development of CHF."

IDF: [Study title: Risk of congestive heart failure after the initiation of hyperglycaemic therapies. Abstract 1055] The study was sponsored by GlaxoSmithKline, Inc., in Collegeville, Pennsylvania.

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