RT Journal Article
SR Electronic
T1 Insulin treatment in patients with diabetes mellitus and heart failure in the era of new antidiabetic medications
JF BMJ Open Diabetes Research & Care
JO BMJ Open Diab Res Care
FD American Diabetes Association
SP e002708
DO 10.1136/bmjdrc-2021-002708
VO 10
IS 2
A1 Lidia Staszewsky
A1 Marta Baviera
A1 Mauro Tettamanti
A1 Pierluca Colacioppo
A1 Fabio Robusto
A1 Antonio D'Ettorre
A1 Vito Lepore
A1 Ida Fortino
A1 Lucia Bisceglia
A1 Ettore Attolini
A1 Elisabetta Anna Graps
A1 Gianluca Caldo
A1 Maria Carla Roncaglioni
A1 Silvio Garattini
A1 Roberto Latini
YR 2022
UL http://drc.bmj.com/content/10/2/e002708.abstract
AB Background Coexistent heart failure (HF) and diabetes mellitus (DM) are associated with marked morbidity and mortality. Optimizing treatment strategies can reduce the number and severity of events. Insulin is frequently used in these patients, but its benefit/risk ratio is still not clear, particularly since new antidiabetic drugs that reduce major adverse cardiac events (MACEs) and renal failure have recently come into use. Our aim is to compare the clinical effects of insulin in a real-world setting of first-time users, with sodium-glucose cotransporter-2 inhibitor (SGLT-2i), glucagon-like peptide-1 receptor agonist (GLP-1RA) and the other antihyperglycemic agents (other-AHAs).Methods We used the administrative databases of two Italian regions, during the years 2010–2018. Outcomes in whole and propensity-matched cohorts were examined using Cox models. A meta-analysis was also conducted combining the data from both regions.Results We identified 34 376 individuals ≥50 years old with DM and HF; 42.0% were aged >80 years and 46.7% were women. SGLT-2i and GLP-1RA significantly reduced MACE compared with insulin and particularly death from any cause (SGLT-2i, hazard ratio (95% CI) 0.29 (0.23 to 0.36); GLP-1RA, 0.482 (0.51 to 0.42)) and first hospitalization for HF (0.57 (0.40 to 0.81) and 0.67 (0.59 to 0.76)).Conclusions In patients with DM and HF, SGLT-2i and GLP-1RA significantly reduced MACE compared with insulin, and particularly any cause of death and first hospitalization for HF. These groups of medications had high safety profiles compared with other-AHAs and particularly with insulin. The inadequate optimization of HF and DM cotreatment in the insulin cohort is noteworthy.Data are available on reasonable request.