Long-acting insulin analogues and diabetic retinopathy: A retrospective cohort study
Resource
Clin. Ther., 36(9), 1255-1268
Journal
Clinical Therapeutics
Journal Volume
36
Journal Issue
9
Pages
1255-1268
Date Issued
2014
Abstract
Purpose: Long-acting insulin analogues were developed to facilitate consistent glycemic control without excessive hypoglycemia. However, structural modifications of the insulin molecule can alter biological responses and binding characteristics with specific receptors. The aim of this study was to estimate the risk of sight-threatening diabetic retinopathy (STDR) associated with treatment using long-acting insulin analogues compared with intermediate-acting insulin in patients with type 2 diabetes mellitus (T2DM). Methods: A retrospective cohort consisting of patients with T2DM aged 20 years of age and older with newly initiated treatment with long-acting insulin analogues (glargine and detemir) and intermediate-acting human insulin was identified from the National Health Insurance database between January 2004 and December 2006 and was subdivided into different cohorts. The risk of the development of STDR was determined by Cox regression models and compared between different cohorts. Findings: Of the 46,739 eligible patients, initiators of insulin glargine, insulin detemir, and neutral protamine Hagedorn (NPH) insulin were identified for comparison using propensity-score matching methods. Long-acting insulin analogues were not associated with changed risk for STDR by intention-to-treat and time-varying use approaches between either matched or unmatched cohorts. Implications: The strategies that aim at preventing diabetic retinopathy by treating T2DM patients with long-acting insulin analogues remain further prospective studies with longer follow-up period to validate our observations within an appropriate dosage range and to further evaluate the safety of long-acting insulin analogues on reducing the progression of diabetic retinopathy. ? 2014 Elsevier HS Journals, Inc. All rights reserved.
Subjects
Detemir; Diabetes; Glargine; Long-acting insulin analogues; Sight-threatening diabetic retinopathy
SDGs
Other Subjects
insulin detemir; insulin glargine; isophane insulin; long acting insulin; antidiabetic agent; glucose blood level; insulin; insulin detemir; insulin glargine; isophane insulin; long acting insulin; adult; aged; Article; Charlson Comorbidity Index; cohort analysis; comorbidity; controlled study; diabetic angiopathy; diabetic nephropathy; diabetic neuropathy; diabetic retinopathy; disease course; drug safety; female; glycemic control; hospitalization; human; insulin treatment; intention to treat analysis; major clinical study; male; non insulin dependent diabetes mellitus; proliferative retinopathy; retrospective study; complication; Diabetes Mellitus, Type 2; diabetic retinopathy; glucose blood level; incidence; metabolism; middle aged; propensity score; Taiwan; very elderly; young adult; Adult; Aged; Aged, 80 and over; Blood Glucose; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Disease Progression; Female; Humans; Hypoglycemic Agents; Incidence; Insulin; Insulin Detemir; Insulin Glargine; Insulin, Isophane; Insulin, Long-Acting; Male; Middle Aged; Propensity Score; Retrospective Studies; Taiwan; Young Adult
Type
journal article