Insulin therapy in patients with type 2 diabetes and high insulin resistance is associated with increased risk of complications and mortality. Postgrad Med 2019 Aug;131(6):376-382
Date
07/18/2019Pubmed ID
31311382Pubmed Central ID
PMC7052790DOI
10.1080/00325481.2019.1643635Scopus ID
2-s2.0-85071999184 (requires institutional sign-in at Scopus site) 14 CitationsAbstract
Objective: To investigate the relationship between insulin use and clinical outcomes in patients with type 2 diabetes stratified by level of insulin resistance (IR).Methods: Cross sectional analysis of the NHANES database from 2001 to 2010. Sample was comprised of 3,124 individuals with diabetes, representing a US population of 16,713,593. Insulin use was self-reported. Fasting glucose and insulin levels were used to assess IR by HOMA-IR determination. Subjects were allocated within High or Low HOMA-IR groups based on the sample median. Outcome variables were mortality, major adverse cardiovascular events (MACE), and diabetic kidney disease (DKD). Logistic regression adjusting for covariates including glycemic control and comorbidities were performed.Results: In the adjusted model, insulin use was significantly associated with increased risk of mortality (OR: 2.39, 95% CI: 1.136-5.010) having a MACE (OR: 2.45, 95% CI: 1.137-4.550), and developing DKD (OR: 1.89, 95% CI: 1.119-3.198) in the high HOMA-IR group. The association between insulin use and the outcome variables was not statistically significant in patients within the low HOMA-IR group.Conclusions: Insulin use was associated with increased risk of mortality, MACE, and DKD in patients within the high IR group, but the association was not significant within the low IR group. Our findings indicate that insulin therapy could be less beneficial in patients with high IR. Prospective studies are needed to identify subsets of individuals with type 2 diabetes who would benefit the most from insulin therapy, and for which patients, insulin should be avoided.
Author List
Mendez CE, Walker RJ, Eiler CR, Mishriky BM, Egede LEAuthors
Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of WisconsinCarlos Eduardo Mendez Castrillo MD Associate Professor in the Medicine department at Medical College of Wisconsin
Rebekah Walker PhD Associate Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Age FactorsAged
Blood Glucose
Blood Pressure
Body Mass Index
Cardiovascular Diseases
Comorbidity
Cross-Sectional Studies
Diabetes Mellitus, Type 2
Diabetic Nephropathies
Disease Progression
Female
Glomerular Filtration Rate
Humans
Hypoglycemic Agents
Insulin
Insulin Resistance
Male
Middle Aged
Risk Factors
Sex Factors
Socioeconomic Factors