title: Cardiovascular Mortality in Type 2 Diabetes Patients with Incident Exposure to Insulin Glargine.
abstract: The study investigated the impact of insulin glargine exposure on cardiovascular mortality in type 2 diabetes patients with incident insulin initiation. All consecutive diabetes patients aged >40 years were screened at their first diabetes outpatient visit between 01/01/2001 and 12/31/2008 (n = 79869). Exclusion criteria restricted the cohort to 4990 incident insulin users, aged 40-79 years, who were followed up for death until 12/31/2011. Baseline was defined 6 months after insulin initiation. Adjusted time-dependent competing risk regression analysis was performed. Mean baseline age was 62 ± 9 years, with mean follow-up of 4.7 ± 1.9 years. During 23179 person-years of exposure time, there were 887 deaths (521 cardiovascular). Glargine cumulative time exposure significantly lowered overall cardiovascular, subhazard ratio (SHR) 0.963 (CI 95% 0.944-0.981, p < 0.001), and myocardial infarction mortality, SHR 0.945 (CI 95% 0.899-0.994, p = 0.028), but not stroke mortality. Glargine cumulative dose exposure (10,000 IU increments) significantly lowered cardiovascular mortality, SHR 0.977 (CI 95% 0.960-0.993, p = 0.006), but not for myocardial infarction and stroke. Both cumulative dose and time exposure to insulin glargine were associated with lower cardiovascular mortality. The effect was mostly driven by myocardial infarction end point, supporting the concept of macrovascular benefit for basal analogue insulin use in type 2 diabetes.
authors.affiliation: "Elias" Emergency University Hospital, Marasti Boulevard 17, 011461 Bucharest, Romania ; "Carol Davila" University of Medicine and Pharmacy, Eroii Sanitari 8, 050474 Bucharest, Romania.
authors.forename: Sorin
authors.initials: S
authors.lastname: Ioacara
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, Eroii Sanitari 8, 050474 Bucharest, Romania ; "Prof. NC Paulescu" National Institute of Diabetes, Nutrition and Metabolic Diseases, Ion Movila 5-7, 020475 Bucharest, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Guja
authors.affiliation: "Elias" Emergency University Hospital, Marasti Boulevard 17, 011461 Bucharest, Romania ; "Carol Davila" University of Medicine and Pharmacy, Eroii Sanitari 8, 050474 Bucharest, Romania ; "Victor Babes" National Research and Development Institute of Pathology and Biomedical Sciences, Splaiul Independentei 99-101, 050096 Bucharest, Romania.
authors.forename: Aura
authors.initials: A
authors.lastname: Reghina
authors.affiliation: "Elias" Emergency University Hospital, Marasti Boulevard 17, 011461 Bucharest, Romania ; "Carol Davila" University of Medicine and Pharmacy, Eroii Sanitari 8, 050474 Bucharest, Romania.
authors.forename: Sorina
authors.initials: S
authors.lastname: Martin
authors.affiliation: "Elias" Emergency University Hospital, Marasti Boulevard 17, 011461 Bucharest, Romania ; "Carol Davila" University of Medicine and Pharmacy, Eroii Sanitari 8, 050474 Bucharest, Romania.
authors.forename: Anca
authors.initials: A
authors.lastname: Sirbu
authors.affiliation: "Elias" Emergency University Hospital, Marasti Boulevard 17, 011461 Bucharest, Romania ; "Carol Davila" University of Medicine and Pharmacy, Eroii Sanitari 8, 050474 Bucharest, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Fica
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015994:Incidence; D000069036:Insulin Glargine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D020521:Stroke / Q000401:mortality*; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D000069036:Insulin Glargine