title: Insulin treatment may not be associated with worse prognosis in acute heart failure diabetic patients.
abstract: BACKGROUND
  Diabetic patients with heart failure (HF) treated with insulin appear to have a worse prognosis compared to oral anti-diabetic (OAD) agents. Whether insulin is a risk factor or a marker of disease severity is unknown. We studied the prognostic impact of insulin treatment in an acute HF diabetic population.
  
  
  METHODS
  From a prospectively recruited population of hospital-admitted acute HF patients we retrospectively selected a convenience sample. Pair-matched analysis: each insulin-treated patient was matched with a diabetic patient with similar glycated hemoglobin (HbA1c±0.2%) under OAD. End-point: all-cause death.
  
  
  RESULTS
  5 years. Insulin-treated and OAD-treated patients were compared. Multivariate Cox-regression analysis was used to analyze the prognostic impact of insulin.
  
  
  RESULTS
  We studied 92 patients: 46 insulin-treated and 46 HbA1c-matched under OAD. Mean age: 74±9 years, 46.7% male and 63.5% had HF with reduced ejection fraction. HbA1c was 7.8±1.5% in both groups. In the subgroup under OAD: 87.0% metformin, 41.3% sulphonylurea, 28.3% dipeptidyl peptidase-4 inhibitors and 4.3% other agents. Insulin-treated patients had lower hemoglobin, higher creatinine and discharged B-type natriuretic peptide (BNP) levels (816.6 [289.2-1805.8] vs. 613.3 [205.6-1110.8]; P=0.02). Seventy three patients died. There were no differences in mortality up to 5 years. After multivariate adjustment accounting for hemoglobin, creatinine and discharge BNP, HR for 1-, 2-, 3-, and 5-year all-cause death in insulin-treated patients were 1.48 (0.62-3.54); P=0.38, 1.11 (0.55-2.25); P=0.77, 1.08 (0.56-2.08); P=0.28 and 1.24 (0.70-2.19); P=0.46, respectively.
  
  
  CONCLUSIONS
  Insulin-treated diabetic patients with HF and HbA1c-matched patients treated with OAD have similarly ominous prognosis. Our results favor insulin as a marker of poor health condition.
authors: Department of Endocrinology, Diabetes and Metabolism, Hospital of São João, Porto, Portugal - filipemrcunha@gmail.com.
authors: Filipe M
authors: FM
authors: Cunha
authors: Department of Internal Medicine, Hospital of São João, Porto, Portugal.
authors: Pedro
authors: P
authors: Marques
authors: Department of Internal Medicine, Hospital of São João, Porto, Portugal.
authors: Joana
authors: J
authors: Pereira
authors: Department of Internal Medicine, Hospital of São João, Porto, Portugal.
authors: Maria J
authors: MJ
authors: Pinto
authors: Department of Internal Medicine, Hospital of São João, Porto, Portugal.
authors: Pedro
authors: P
authors: Rodrigues
authors: Department of Internal Medicine, Hospital of São João, Porto, Portugal.
authors: Helena
authors: H
authors: Moreira
authors: Department of Internal Medicine, Hospital of São João, Porto, Portugal.
authors: Patrícia
authors: P
authors: Lourenço
authors: Department of Internal Medicine, Hospital of São João, Porto, Portugal.|Faculty of Medicine, University of Porto, Porto, Portugal.
authors: Paulo
authors: P
authors: Bettencourt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002423:Cause of Death; D058065:Diabetic Cardiomyopathies / Q000150:complications / Q000453:epidemiology*; D023381:Endpoint Determination; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D007004:Hypoglycemic Agents; D007328:Insulin