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Insulin Dose and Cardiovascular Mortality in the ACCORD Trial.
Siraj, Elias S; Rubin, Daniel J; Riddle, Matthew C; Miller, Michael E; Hsu, Fang-Chi; Ismail-Beigi, Faramarz; Chen, Shyh-Huei; Ambrosius, Walter T; Thomas, Abraham; Bestermann, William; Buse, John B; Genuth, Saul; Joyce, Carol; Kovacs, Christopher S; O'Connor, Patrick J; Sigal, Ronald J; Solomon, Sol.
Afiliação
  • Siraj ES; Temple University School of Medicine, Philadelphia, PA esiraj@temple.edu.
  • Rubin DJ; Temple University School of Medicine, Philadelphia, PA.
  • Riddle MC; Oregon Health & Science University School of Medicine, Portland, OR.
  • Miller ME; Wake Forest School of Medicine, Winston-Salem, NC.
  • Hsu FC; Wake Forest School of Medicine, Winston-Salem, NC.
  • Ismail-Beigi F; Case Western Reserve University School of Medicine, Cleveland, OH.
  • Chen SH; Wake Forest School of Medicine, Winston-Salem, NC.
  • Ambrosius WT; Wake Forest School of Medicine, Winston-Salem, NC.
  • Thomas A; Henry Ford Medical Center, Detroit, MI.
  • Bestermann W; Holston Medical Group, Kingsport, TN.
  • Buse JB; University of North Carolina School of Medicine, Chapel Hill, NC.
  • Genuth S; Case Western Reserve University School of Medicine, Cleveland, OH.
  • Joyce C; Memorial University Health Sciences Centre, St. John's, NL, Canada.
  • Kovacs CS; Memorial University Health Sciences Centre, St. John's, NL, Canada.
  • O'Connor PJ; HealthPartners Institute for Education and Research, Minneapolis, MN.
  • Sigal RJ; University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
  • Solomon S; Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, TN.
Diabetes Care ; 38(11): 2000-8, 2015 Nov.
Article em En | MEDLINE | ID: mdl-26464212
OBJECTIVE: In the ACCORD trial, intensive treatment of patients with type 2 diabetes and high cardiovascular (CV) risk was associated with higher all-cause and CV mortality. Post hoc analyses have failed to implicate rapid reduction of glucose, hypoglycemia, or specific drugs as the causes of this finding. We hypothesized that exposure to injected insulin was quantitatively associated with increased CV mortality. RESEARCH DESIGN AND METHODS: We examined insulin exposure data from 10,163 participants with a mean follow-up of 5 years. Using Cox proportional hazards models, we explored associations between CV mortality and total, basal, and prandial insulin dose over time, adjusting for both baseline and on-treatment covariates including randomized intervention assignment. RESULTS: More participants allocated to intensive treatment (79%) than standard treatment (62%) were ever prescribed insulin in ACCORD, with a higher mean updated total daily dose (0.41 vs. 0.30 units/kg) (P < 0.001). Before adjustment for covariates, higher insulin dose was associated with increased risk of CV death (hazard ratios [HRs] per 1 unit/kg/day 1.83 [1.45, 2.31], 2.29 [1.62, 3.23], and 3.36 [2.00, 5.66] for total, basal, and prandial insulin, respectively). However, after adjustment for baseline covariates, no significant association of insulin dose with CV death remained. Moreover, further adjustment for severe hypoglycemia, weight change, attained A1C, and randomized treatment assignment did not materially alter this observation. CONCLUSIONS: These analyses provide no support for the hypothesis that insulin dose contributed to CV mortality in ACCORD.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Diabetes Mellitus Tipo 2 / Hipoglicemiantes / Insulina Tipo de estudo: Clinical_trials / Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Diabetes Care Ano de publicação: 2015 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Diabetes Mellitus Tipo 2 / Hipoglicemiantes / Insulina Tipo de estudo: Clinical_trials / Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Diabetes Care Ano de publicação: 2015 Tipo de documento: Article País de publicação: Estados Unidos