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.
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.
Khalangot
Mykola
M
V.P. Komisarenko Institute of Endocrinology and Metabolism, Kiev, Ukraine.
Tronko
Mykola
M
Kravchenko
Victor
V
Kulchinska
Jaroslava
J
Hu
Gang
G
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
D007004:Hypoglycemic Agents; D007328:Insulin