Medical College of Wisconsin, Director Diabetes Program, Zablocki VA Medical Center, Milwaukee, WI, USA.
Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Postgrad Med. 2019 Aug;131(6):376-382. doi: 10.1080/00325481.2019.1643635. Epub 2019 Jul 23.
: To investigate the relationship between insulin use and clinical outcomes in patients with type 2 diabetes stratified by level of insulin resistance (IR).: 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.: 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.: 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.
: 目的：探讨按胰岛素抵抗（IR）水平分层的 2 型糖尿病患者中胰岛素使用与临床结局的关系。: 2001 年至 2010 年 NHANES 数据库的横断面分析。样本由 3124 名糖尿病患者组成，代表了 16713593 名美国人口。胰岛素使用情况为自我报告。通过 HOMA-IR 测定评估空腹血糖和胰岛素水平来评估 IR。根据样本中位数将受试者分配到高或低 HOMA-IR 组。结局变量为死亡率、主要不良心血管事件（MACE）和糖尿病肾病（DKD）。调整包括血糖控制和合并症在内的协变量的逻辑回归分析。: 在调整后的模型中，胰岛素的使用与高 HOMA-IR 组的死亡率（OR：2.39，95%CI：1.136-5.010）、MACE（OR：2.45，95%CI：1.137-4.550）和 DKD（OR：1.89，95%CI：1.119-3.198）的发生风险显著相关。在低 HOMA-IR 组的患者中，胰岛素的使用与结局变量之间的关联没有统计学意义。: 在高 IR 组的患者中，胰岛素的使用与死亡率、MACE 和 DKD 的发生风险增加相关，但在低 IR 组中，这种关联没有统计学意义。我们的研究结果表明，在高 IR 患者中，胰岛素治疗的益处可能较小。需要前瞻性研究来确定最受益于胰岛素治疗的 2 型糖尿病患者亚组，以及哪些患者应避免使用胰岛素。
