Mehr Tote unter Insulinbehandlung im Vergleich zu

31.Januar 2013

Mehr Tote unter Insulinbehandlung im Vergleich zu Metformin?
Das klingt ja erschreckend, wenn man das Abstract liest (den vollen Orininaltext habe ich noch nicht vorliegen; man muss ihn kostenpflichtig anfordern.)
Erst beim letzten Satz des Abstracts kann man wieder durchatmen:
Differences in baseline characteristics between treatment groups should be considered when interpreting these results.
// Also erst mal sehen, wie wirklich verglichen wurde und den gesamten Text abwarten.

Mortality and Other Important Diabetes-Related Outcomes With Insulin vs Other Antihyperglycemic Therapies in Type 2 Diabetes

The safety of insulin in the treatment of type 2 diabetes mellitus (T2DM) has recently undergone scrutiny.
Objective: The objective of the study was to characterize the risk of adverse events associated with glucose-lowering therapies in people with T2DM.
Design and Setting: This was a retrospective cohort study using data from the UK General Practice Research Database, 2000–2010.
Patients: Patients comprised 84 622 primary care patients with T2DM treated with one of five glucose-lowering regimens: metformin monotherapy, sulfonylurea monotherapy, insulin monotherapy, metformin plus sulfonylurea combination therapy, and insulin plus metformin combination therapy. There were 105 123 exposure periods.
Main Outcome Measures: The risk of the first major adverse cardiac event, first cancer, or mortality was measured. Secondary outcomes included these individual constituents and microvascular complications.
Results: In the same model, and using metformin monotherapy as the referent, the adjusted hazard ratio (aHR) for the primary end point was significantly increased for sulfonylurea monotherapy (1.436, 95% confidence interval [CI] 1.354–1.523), insulin monotherapy (1.808, 95% CI 1.630–2.005), and insulin plus metformin (1.309, 95% CI 1.150–1.491). In glycosylated hemoglobin/morbidity subgroups, patients treated with insulin monotherapy had aHRs for the primary outcome ranging from 1.469 (95% CI 0.978–2.206) to 2.644 (95% CI 1.896–3.687). For all secondary outcomes, insulin monotherapy had increased aHRs: myocardial infarction (1.954, 95% CI 1.479–2.583), major adverse cardiac events (1.736, 95% CI 1.441–2.092), stroke (1.432, 95% CI 1.159–1.771), renal complications (3.504, 95% CI 2.718–4.518), neuropathy (2.146, 95% CI 1.832–2.514), eye complications (1.171, 95% CI 1.057–1.298), cancer (1.437, 95% CI 1.234–1.674), or all-cause mortality (2.197, 95% CI 1.983–2.434). When compared directly, aHRs were higher for insulin monotherapy vs all other regimens for the primary end point and all-cause mortality.
Conclusions: In people with T2DM, exogenous insulin therapy was associated with an increased risk of diabetes-related complications, cancer, and all-cause mortality. Differences in baseline characteristics between treatment groups should be considered when interpreting these results.