title: Long-term mortality in patients with type 2 diabetes undergoing coronary angiography: the impact of glucose-lowering treatment.
abstract: OBJECTIVE
  The aim of this study was to analyse whether the increased mortality rates observed in insulin-treated patients with type 2 diabetes and coronary artery disease are explained by comorbidities and complications.
  
  
  METHODS
  A retrospective analysis of data from two Swedish registries of type 2 diabetic patients (n = 12,515) undergoing coronary angiography between the years 2001 and 2009 was conducted. The association between glucose-lowering treatment and long-term mortality was studied after extensive adjustment for cardiovascular- and diabetes-related confounders. Patients were classified into four groups, according to glucose-lowering treatment: diet alone; oral therapy alone; insulin in combination with oral therapy; and insulin alone.
  
  
  RESULTS
  After a mean follow-up time of 4.14 years, absolute mortality rates for patients treated with diet alone, oral therapy alone, insulin in combination with oral therapy and insulin alone were 19.2%, 17.4%, 22.9% and 28.1%, respectively. Compared with diet alone, insulin in combination with oral therapy (HR 1.27; 95% CI 1.12, 1.43) and insulin alone (HR 1.62; 95% CI 1.44, 1.83) were associated with higher mortality rates. After adjustment for baseline differences, insulin in combination with oral glucose-lowering treatment (HR 1.22; 95% CI 1.06, 1.40; p < 0.005) and treatment with insulin only (HR 1.17; 95% CI 1.02, 1.35; p < 0.01) remained independent predictors for long-term mortality.
  
  
  CONCLUSIONS
  Type 2 diabetes patients treated with insulin and undergoing coronary angiography have a higher long-term mortality risk after adjustment for measured confounders. Further research is needed to evaluate the optimal glucose-lowering treatment for these high-risk patients.
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska University Hospital, N3:06, Solna, 171 76, Stockholm, Sweden.
authors.forename: N
authors.initials: N
authors.lastname: Saleh
authors.forename: P
authors.initials: P
authors.lastname: Petursson
authors.forename: B
authors.initials: B
authors.lastname: Lagerqvist
authors.forename: H
authors.initials: H
authors.lastname: Skúladóttir
authors.forename: A
authors.initials: A
authors.lastname: Svensson
authors.forename: B
authors.initials: B
authors.lastname: Eliasson
authors.forename: S
authors.initials: S
authors.lastname: Gudbjörnsdottir
authors.forename: K
authors.initials: K
authors.lastname: Eeg-Olofsson
authors.forename: A
authors.initials: A
authors.lastname: Norhammar
mesh_terms: D000368:Aged; D015897:Comorbidity; D017023:Coronary Angiography / Q000401:mortality / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D004035:Diet Therapy / Q000706:statistics & numerical data*; 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; D012189:Retrospective Studies; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin