title: The joint effects of different types of glucose-lowering treatment and duration of diabetes on total and cardiovascular mortality among subjects with type 2 diabetes.
abstract: OBJECTIVE
  To compare the joint effects of different types of glucose-lowering treatment (oral drugs, insulin, and both) and duration of diabetes on total and cardiovascular mortality among diabetic patients.
  
  
  METHODS
  Study cohorts included 30,534 Ukrainian males and 58,909 females with type 2 diabetes. During the mean follow-up of 2.7 years, 7804 deaths were recorded.
  
  
  RESULTS
  The multivariate-adjusted hazard ratios (HRs) for total mortality among diabetic patients, who used oral glucose-lowering drug (OGLD) only, insulin only, both insulin and OGLD, were 1.00, 2.34, and 2.22 in men, and 1.00, 2.12, and 2.20 in women, respectively. The multivariate-adjusted HRs for total mortality across categories of duration of diabetes (<5, 5-9, 10-14, 15-19, and >/=20 years) were 1.00, 1.17, 1.32, 1.43, and 1.57 (p(trend)<0.001) in men, and 1.00, 1.13, 1.34, 1.74, and 1.68 (p(trend)<0.001) in women, respectively. Diabetic patients who used insulin and reported longer duration of diabetes had the highest risk of total mortality.
  
  
  CONCLUSIONS
  Type 2 diabetic patients treated with insulin show a greater risk of death than those treated with OGLD only. Increasing duration of diabetes is associated with an increased death risk. The combination of insulin treatment and longer duration of diabetes identifies a particular high death risk.
authors.affiliation: V.P. Komisarenko Institute of Endocrinology and Metabolism, Kiev, Ukraine.
authors.forename: Mykola
authors.initials: M
authors.lastname: Khalangot
authors.forename: Mykola
authors.initials: M
authors.lastname: Tronko
authors.forename: Victor
authors.initials: V
authors.lastname: Kravchenko
authors.forename: Jaroslava
authors.initials: J
authors.lastname: Kulchinska
authors.forename: Gang
authors.initials: G
authors.lastname: Hu
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D004358:Drug Therapy / Q000379:methods / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014455:Ukraine / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin