在极高动脉粥样硬化性心血管疾病风险的 2 型糖尿病患者中，地特胰岛素与甘精胰岛素的心血管结局相似。

Similar Cardiovascular Outcomes Between Insulin Detemir and Insulin Glargine In Type 2 Diabetic Patients With Extremely Atherosclerotic Cardiovascular Disease Risks.

机构信息

Tien-Hsing Chen and Chih-Ching Wang contributed equally as the first author.; From the Division of Cardiology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.

Tien-Hsing Chen and Chih-Ching Wang contributed equally as the first author.; the Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.

出版信息

Endocr Pract. 2020 Aug;26(8):818-829. doi: 10.4158/EP-2019-0552.

DOI:10.4158/EP-2019-0552

PMID:33471673

Abstract

OBJECTIVE

The cardiovascular outcomes of insulin detemir in patients with type 2 diabetes mellitus (T2DM) after acute coronary syndrome (ACS) or acute ischemic stroke (AIS) are unclear. The aim of our real-life cohort study was to evaluate the cardiovascular outcomes of insulin detemir (IDet) versus insulin glargine (IGlar) in T2DM patients after ACS or AIS.

METHODS

A retrospective cohort study was conducted between June 1, 2005, and December 31, 2013, utilizing the Taiwan National Health Insurance Research Database. A total of 3,129 ACS or AIS patients were eligible for the analysis. Clinical outcomes were evaluated by comparing 1,043 subjects receiving IDet with 2,086 propensity score-matched subjects who received IGlar. The primary composite outcome included cardiovascular (CV) death, nonfatal myocardial infarction (MI) and nonfatal stroke.

RESULTS

The primary composite outcome occurred in 322 patients (30.9%) in the IDet group and 604 patients (29.0%) in the IGlar group (hazard ratio [HR], 1.12; 95% confidence interval [CI], 0.95 to 1.32) with a mean follow-up of 2.4 years. No significant differences were observed for CV death (HR, 1.09; 95% CI, 0.86 to 1.38), nonfatal MI (HR, 0.88; 95% CI, 0.66 to 1.19), and nonfatal stroke (HR, 1.15; 95% CI, 0.97 to 1.35). There were similar risks of all-cause mortality, hospitalization for heart failure and revascularization between the IDet group and the IGlar group (P = .647, .115, and .390 respectively).

CONCLUSION

Compared with IGlar, in T2DM patients after ACS or AIS, IDet was not associated with increased risks of CV death, nonfatal MI, or nonfatal stroke.

ABBREVIATIONS

ACS = acute coronary syndrome; AIS = acute ischemic stroke; ASCVD = atherosclerotic cardiovascular disease; CI = confidence interval; CV = cardiovascular; DKA = diabetic ketoacidosis; HHF = hospitalization for heart failure; HHS = hyperosmolar hyperglycemic state; HR = hazard ratio; IDet = insulin detemir; IGlar = insulin glargine; MI = myocardial infarction; NHIRD = National Health Insurance Research Database; PCI = percutaneous coronary intervention; PSM = propensity score matching; T2DM = type 2 diabetes mellitus.

摘要

目的

胰岛素地特胰岛素在急性冠状动脉综合征（ACS）或急性缺血性脑卒中（AIS）后 2 型糖尿病（T2DM）患者中的心血管结局尚不清楚。我们真实世界队列研究的目的是评估 T2DM 患者 ACS 或 AIS 后使用胰岛素地特胰岛素（IDet）与甘精胰岛素（IGlar）的心血管结局。

方法

这是一项回顾性队列研究，于 2005 年 6 月 1 日至 2013 年 12 月 31 日期间利用台湾全民健康保险研究数据库进行。共有 3129 名 ACS 或 AIS 患者符合分析条件。通过比较接受 IDet 的 1043 例患者和接受 IGlar 的 2086 例倾向评分匹配患者，评估临床结局。主要复合结局包括心血管（CV）死亡、非致死性心肌梗死（MI）和非致死性卒中。

结果

IDet 组 322 例（30.9%）和 IGlar 组 604 例（29.0%）患者发生主要复合结局（风险比[HR]，1.12；95%置信区间[CI]，0.95 至 1.32），平均随访时间为 2.4 年。CV 死亡（HR，1.09；95%CI，0.86 至 1.38）、非致死性 MI（HR，0.88；95%CI，0.66 至 1.19）和非致死性卒中（HR，1.15；95%CI，0.97 至 1.35）无显著差异。IDet 组和 IGlar 组之间全因死亡率、心力衰竭住院和血运重建的风险相似（P =.647，.115 和.390）。