Association between insulin‐induced weight change and CVD mortality: Evidence from a historic cohort study of 18, 814 patients in UK primary care. Issue 1 (19th October 2017)

• Record Type: Journal Article
• Authors: Anyanwagu, Uchenna; Mamza, Jil; Donnelly, Richard; Idris, Iskandar
• Is Part Of: Diabetes/metabolism research and reviews. Volume 34:Issue 1(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-10-19
• Subjects: cardiovascular -- insulin -- mortality -- weight‐change; Diabetes -- Periodicals; Metabolism -- Periodicals; 616.642
• DOI: 10.1002/dmrr.2945
• Languages: English
• ISSNs: 1520-7552

Abstract

Abstract: Background: This study explores the association of insulin‐induced weight (wt) gain on cardiovascular outcomes and mortality among patients with type 2 diabetes (T2D) following insulin initiation using real‐world data. Methods: A historical cohort study was performed in 18, 814 adults with insulin‐treated T2D derived from the UK The Health Improvement Network database. Based on the average weight change of 5 kg, 1 year postinsulin initiation, patients were grouped into 5 categories (>5 kg wt loss; 1.0‐5.0 kg wt loss; no wt change; 1.0‐5.0 kg wt gain; >5.0 kg wt gain) and followed‐up for 5 years. Cox proportional hazard models and Kaplan‐Meier estimators were fitted to estimate the hazards of a 3‐point composite of nonfatal myocardial infarction, stroke, and all‐cause mortality between categories. Results: The median age was 62.8 (IQR: 52.3–71.8) years, HbA1c : 8.6% (IQR: 7.4–9.8) and mean BMI: 31.8 (6.5) kg/m 2 . The 5 year probability of survival differed significantly within the wt‐change categories (log‐rank test P value = .0005). Only 1963 composite events occurred. Compared with the weight‐neutral group, the risk of composite events was 31% greater in the >5 kg wt‐loss group (aHR: 1.31; 95% CI: 1.02, 1.68), the same in the 1.0 to 5.0 kg wt‐gain category, but nonsignificantly increased in the 1.0 to 5.0 kg wt loss (15%) and >5.0 kg wt gain (13%) categories, respectively. In the obese subgroup, this risk was 50% (aHR: 1.50, 95% CI: 1.08‐2.08) more in the >5 kg weight‐loss group compared with the weight‐neutral group. Conclusion: Insulin‐induced weight gain did not translate to adverse cardiovascular outcomes and mortality in patients with T2D. These data provide reassurance on the cardiovascular safety of insulin patients with T2D.