title: All-Cause and Cause-Specific Mortality among Users of Basal Insulins NPH, Detemir, and Glargine.
abstract: BACKGROUND
  Insulin therapy in type 2 diabetes may increase mortality and cancer incidence, but the impact of different types of basal insulins on these endpoints is unclear. Compared to the traditional NPH insulin, the newer, longer-acting insulin analogues detemir and glargine have shown benefits in randomized controlled trials. Whether these advantages translate into lower mortality among users in real life is unknown.
  
  
  OBJECTIVE
  To estimate the differences in all-cause and cause-specific mortality rates between new users of basal insulins in a population-based study in Finland.
  
  
  METHODS
  23 751 individuals aged ≥40 with type 2 diabetes, who initiated basal insulin therapy in 2006-2009 were identified from national registers, with comprehensive data for mortality, causes of death, and background variables. Propensity score matching was performed on characteristics. Follow-up time was up to 4 years (median 1.7 years).
  
  
  RESULTS
  2078 deaths incurred. With NPH as reference, the adjusted HRs for all-cause mortality were 0.39 (95% CI, 0.30-0.50) for detemir, and 0.55 (95% CI, 0.44-0.69) for glargine. As compared to glargine, the HR was 0.71 (95% CI, 0.54-0.93) among detemir users. Compared to NPH, the mortality risk for both cardiovascular causes as well as cancer were also significantly lower for glargine, and especially for detemir in adjusted analysis. Furthermore, the results were robust in various sensitivity analyses.
  
  
  CONCLUSIONS
  In real clinical practice, mortality was substantially higher among users of NPH insulin as compared to insulins detemir or glargine. Considering the large number of patients who require insulin therapy, this difference in risk may have major clinical and public health implications. Due to limitations of the observational study design, further investigation using an interventional study design is warranted.
authors.affiliation: University of Helsinki, Clinicum, Helsinki, Finland.|Aava Medical Centre, Kerava, Finland.
authors.forename: Arto Y
authors.initials: AY
authors.lastname: Strandberg
authors.affiliation: EPID Research, Espoo, Finland.
authors.forename: Fabian J
authors.initials: FJ
authors.lastname: Hoti
authors.affiliation: University of Helsinki, Clinicum, Helsinki, Finland.|Helsinki University Central Hospital, Helsinki, Finland.|University of Oulu, Center for Life Course Health Research, Oulu, Finland.
authors.forename: Timo E
authors.initials: TE
authors.lastname: Strandberg
authors.affiliation: EPID Research, Espoo, Finland.
authors.forename: Solomon
authors.initials: S
authors.lastname: Christopher
authors.affiliation: EPID Research, Espoo, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Haukka
authors.affiliation: EPID Research, Espoo, Finland.
authors.forename: Pasi
authors.initials: P
authors.lastname: Korhonen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005387:Finland; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069036:Insulin Glargine / Q000627:therapeutic use*; D007336:Insulin, Isophane / Q000627:therapeutic use*; D049528:Insulin, Long-Acting / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality; D012306:Risk
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; D007336:Insulin, Isophane