Abstract
BackgroundIn insulin-treated patients with type 2 diabetes mellitus (T2DM), glycemic control is usually suboptimal.MethodsThis study compared the risks of mortality and cardiovascular events in insulin-treated patients adding or not adding alpha-glucosidase inhibitors (AGIs).ResultsThis cohort study included data from the Taiwan National Health Insurance Research Database. In total, 17,417 patients newly diagnosed as having T2DM and undergoing insulin therapy during 2000–2012 were enrolled. Overall incidence rates of all-cause mortality, hospitalized coronary artery disease (CAD), stroke, and heart failure were compared between 4165 AGI users and 4165 matched nonusers. The incidence rates of all-cause mortality were 17.10 and 19.61 per 1000 person-years in AGI nonusers and users, respectively. Compared with nonusers, AGI users had a higher mortality risk [adjusted hazard ratio (aHR) = 1.21, 95% confidence interval (CI) = 1.05–1.40; p = 0.01]. Regarding AGI use, aHRs (95% CI) for cardiovascular death, non-cardiovascular death, hospitalized CAD, stroke, and heart failure were 1.20 (0.83–1.74), 1.27 (1.07–1.50), 1.12 (0.95–1.31), 0.98 (0.85–1.14), and 1.03 (0.87–1.22) respectively.ConclusionAGI use was associated with higher risks of all-cause mortality and non-cardiovascular death in insulin-treated patients with T2DM. Therefore, adding AGIs in insulin-treated patients may not be appropriate.
Highlights
In insulin-treated patients with type 2 diabetes mellitus (T2DM), glycemic control is usually suboptimal
We considered the use of basal, premixed, and prandial insulin; antidiabetic drugs other than Alpha-glucosidase inhibitor (AGI) after the date of diagnosis of diabetes; antihypertensive drugs [such as angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers, calcium-channel blockers, diuretics, and potassium-sparing diuretics]; statins; and aspirin
In total, 17,417 patients newly diagnosed as having T2DM receiving insulin therapy during 2000–2012 were included (Fig. 1)
Summary
In insulin-treated patients with type 2 diabetes mellitus (T2DM), glycemic control is usually suboptimal. Hyperglycemia increases cardiovascular risks [1]; even when lower than the diabetic threshold, blood glucose levels remain a continuous risk factor for cardiovascular death [2]. After adjustments for major risk factors, type 2 diabetes mellitus (T2DM) is associated with considerably increased risks of premature cardiovascular and. Yki-Järvinen [8] reported that using insulin combination therapy instead of insulin monotherapy can improve glycemic control. AGIs can reduce fasting blood glucose levels and postprandial glucose excursion without increasing body weight. Rice is the staple food in Asian people, AGIs can retard the absorption of carbohydrate and play an important role in controlling blood sugar in this area
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