1418-P: Increased Risk of Incident Heart Failure and All-Cause Mortality in Insulin-Resistant People with Type 2 Diabetes in the United Kingdom Prospective Diabetes Study (UKPDS)

Abstract

Background and Aims: Insulin resistance (IR) is a possible mediator for development of heart failure (HF). We examined prospectively whether IR in people with newly-diagnosed type 2 diabetes (T2D) increased their risk of a composite endpoint of incident HF or all-cause mortality (ACM) (as death is a competing risk). Methods: UKPDS participants with Homeostasis Model Assessment v2 Insulin Resistance (HOMA2_IR) values (derived from paired fasting plasma glucose and insulin measures) were used in multivariable Cox model and Kaplan Meier survival curves to evaluate a possible association between HOMA2_IR and HF/ACM or HF alone, adjusting for potential confounders (variables with a univariate association (P<0.1) and a multivariable P value <0.05 were retained in the full model). Results: Of 5102 UKPDS participants, 4344 had the data required. They were mean (SD) age 52.5 (8.7) years, HbA1c 7.2 (1.8) %, body mass index 28.8 (5.5) kg/m2, with median (IQR) HOMA2_IR 1.6 (1.1-2.2). Over median 16.4 years the composite endpoint occurred in 1974 (45.4%) participants (235 HF, 1897 death first events) with a 27% greater risk for those with HOMA2_IR ≥1.6 (compared with <1.6), and a 55% greater risk for HF (Table). Conclusion: Insulin resistant patients with newly-diagnosed T2D were more likely to develop HF or die than those who were more insulin sensitive. Disclosure M. Wamil: None. R.L. Coleman: None. A. Adler: None. J.J. McMurray: Other Relationship; Self; AbbVie Inc., Alnylam Pharmaceuticals, Amgen, AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Bristol-Myers Squibb, Cardurion, GlaxoSmithKline plc., Novartis Pharmaceuticals Corporation, Theracos, Inc. R.R. Holman: Advisory Panel; Self; Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Bayer AG, Merck Sharp & Dohme Corp. Funding Oxfordshire Health Services Research Committee (1239)