Premium
Association between insulin‐induced weight change and CVD mortality: Evidence from a historic cohort study of 18,814 patients in UK primary care
Author(s) -
Anyanwagu Uchenna,
Mamza Jil,
Donnelly Richard,
Idris Iskandar
Publication year - 2018
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2945
Subject(s) - medicine , hazard ratio , proportional hazards model , weight change , type 2 diabetes , cohort , myocardial infarction , weight gain , insulin , weight loss , cohort study , stroke (engine) , demography , diabetes mellitus , endocrinology , obesity , body weight , confidence interval , mechanical engineering , sociology , engineering
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, HbA 1c : 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.