Lower incidence of recorded cardiovascular outcomes in patients with type 2 diabetes using insulin aspart vs. those on human regular insulin: observational evidence from general practices.

Abstract

AIMS:

Insulin aspart has a higher ability to treat postprandial glucose than regular human insulin, which may have favourable cardiovascular effects. The aim was to collect and compare the incidence of recorded macro- and microvascular events in patients with type 2 diabetes with insulin aspart or regular human insulin in general practices.

METHODS:

Computerized data from 3154 aspart and 3154 regular insulin users throughout Germany (Disease Analyzer, January 2000 to July 2011) were analysed after matching for age (60 ± 10 years), sex (men: 57%), health insurance (private: 5.8%) and diabetes treatment period in practice (2.2 ± 2.5 years). Hazard ratios (HR; Cox regression) for macro- or microvascular outcomes (follow-up: 3.5 years) were further adjusted for diabetologist care, practice region, hypertension, hyperlipidaemia, co-medication (basal insulin, oral antidiabetics, antihypertensives, lipid-lowering agents and antithrombotic drugs), previous treatment with rapid-acting insulins, hypoglycaemia and the Charlson co-morbidity score. Furthermore, adjustment was carried out for baseline microvascular complications when analysing macrovascular outcomes and vice versa.

RESULTS:

Overall, the risk of combined macrovascular outcomes was 15% lower for insulin aspart users (p = 0.01). For insulin aspart there was also a decreased risk incident stroke [HR: 0.58; 95% confidence interval (CI): 0.45-0.74], myocardial infarction (HR: 0.69; 95% CI: 0.54-0.88) and peripheral vascular disease (HR: 0.80; 95% CI: 0.69-0.93). For microvascular complications (retinopathy, neuropathy and nephropathy), no significant differences were observed (HR: 0.96; 95% CI: 0.87-1.06).

CONCLUSION:

Use of the rapid-acting insulin analogue aspart was associated with a reduced incidence of macrovascular outcomes in type 2 diabetes in general practices. It is important to confirm this finding in a randomized controlled trial.

• Authors: W Rathmann, K Kostev
• Journal: Diabetes, obesity & metabolism (Diabetes Obes Metab) Vol. 15 Issue 4 Pg. 358-63 (Apr 2013) ISSN: 1463-1326 [Electronic] England
• PMID: 23137345 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2012 Blackwell Publishing Ltd.

Chemical References

• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin
• hemoglobin A1c protein, human
• Insulin Aspart

Topics

• Aged
• Diabetes Mellitus, Type 2 (complications, drug therapy, physiopathology)
• Diabetic Angiopathies (complications, drug therapy, physiopathology, prevention & control)
• Evidence-Based Medicine
• Female
• General Practice (statistics & numerical data)
• Germany (epidemiology)
• Glycated Hemoglobin (drug effects)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Incidence
• Insulin (analogs & derivatives, therapeutic use)
• Insulin Aspart (therapeutic use)
• Male
• Middle Aged
• Postprandial Period
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome