Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
Diabetes Obes Metab. 2023 Aug;25(8):2279-2289. doi: 10.1111/dom.15106. Epub 2023 May 11.
To determine whether the use of long-acting insulin analogues is associated with an increased risk of incident diabetic retinopathy (DR) among patients with type 2 diabetes.
Using data from the Clinical Practice Research Datalink Aurum, this retrospective, population-based cohort study included patients with type 2 diabetes who initiated a long-acting insulin analogue (glargine, detemir, degludec) or Neutral Protamine Hagedorn (NPH) insulin. The primary outcome was incident DR. We used Cox proportional hazards models with inverse probability of treatment weighting to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident DR with insulin analogues versus NPH insulin.
There were 66 280 new users of long-acting insulin analogues and 66 173 new users of NPH insulin. The incidence rate of DR was 101.7 per 1000 person-years (95% CI, 98.7-104.8) for insulin analogues and 93.2 (95% CI, 90.0-96.5) per 1000 person-years for NPH insulin. Compared with the current use of NPH insulin, insulin analogues were not associated with the risk of incident DR (HR 1.04, 95% CI, 0.99-1.09). The adjusted HRs were 0.84 (95% CI, 0.66-1.07) for proliferative DR and 1.02 (95% CI, 0.97-1.08) for non-proliferative DR.
Compared with NPH insulin, long-acting insulin analogues were not associated with the risk of incident DR among patients with type 2 diabetes. This finding provides important reassurance regarding the safety of long-acting insulin analogues with respect to incident DR.
确定 2 型糖尿病患者使用长效胰岛素类似物是否会增加发生糖尿病视网膜病变（DR）的风险。
本回顾性基于人群的队列研究使用来自临床实践研究数据链接 Aurum 的数据，纳入了起始使用长效胰岛素类似物（甘精胰岛素、地特胰岛素、德谷胰岛素）或中性鱼精蛋白锌胰岛素（NPH）的 2 型糖尿病患者。主要结局是发生 DR。我们使用逆概率治疗加权的 Cox 比例风险模型来估计与 NPH 胰岛素相比，胰岛素类似物发生 DR 的风险比（HR）和 95%置信区间（CI）。
有 66280 名新使用长效胰岛素类似物的患者和 66173 名新使用 NPH 胰岛素的患者。DR 的发生率为胰岛素类似物组为 101.7/1000 人年（95%CI，98.7-104.8），NPH 胰岛素组为 93.2/1000 人年（95%CI，90.0-96.5）。与当前使用 NPH 胰岛素相比，胰岛素类似物与发生 DR 的风险无关（HR 1.04，95%CI，0.99-1.09）。调整后的 HR 分别为增生性 DR 0.84（95%CI，0.66-1.07）和非增生性 DR 1.02（95%CI，0.97-1.08）。
与 NPH 胰岛素相比，长效胰岛素类似物与 2 型糖尿病患者发生 DR 的风险无关。这一发现为长效胰岛素类似物在发生 DR 方面的安全性提供了重要保证。
