Impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus
Abstract Background Patients with diabetes mellitus (DM) have a higher prevalence of heart failure (HF) than those without it. Approximately 40 % of HF patients have DM and they tend to have poorer outcomes than those without DM. This study evaluated the impact of insulin therapy on mortality among...
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doaj-e4575e15f0d5462590a3ec891be13d532021-09-12T11:16:57ZengBMCCardiovascular Diabetology1475-28402021-09-0120111110.1186/s12933-021-01370-yImpact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitusSe Yong Jang0Jieun Jang1Dong Heon Yang2Hyun-Jai Cho3Soo Lim4Eun-Seok Jeon5Sang Eun Lee6Jae-Joong Kim7Seok-Min Kang8Sang Hong Baek9Myeong-Chan Cho10Dong-Ju Choi11Byung-Su Yoo12Kye Hun Kim13Sue K. Park14Hae-Young Lee15Department of Internal Medicine, School of Medicine, Kyungpook National UniversityDepartment of Preventive Medicine, Korea University College of MedicineDepartment of Internal Medicine, School of Medicine, Kyungpook National UniversityDepartment of Internal Medicine, Seoul National University HospitalDepartment of Internal Medicine, Seoul National University Bundang HospitalDepartment of Internal Medicine, Sungkyunkwan University College of MedicineDepartment of Internal Medicine, Asan Medical Center, University of Ulsan College of MedicineDepartment of Internal Medicine, Asan Medical Center, University of Ulsan College of MedicineDepartment of Internal Medicine, Yonsei University College of MedicineDepartment of Internal Medicine, College of Medicine, The Catholic University of KoreaDepartment of Internal Medicine, Chungbuk National University College of MedicineDepartment of Internal Medicine, Seoul National University Bundang HospitalDepartment of Internal Medicine, Yonsei University Wonju College of MedicineDepartment of Internal Medicine, Heart Research Center of Chonnam National UniversityDepartment of Preventive Medicine, Seoul National University College of MedicineDepartment of Internal Medicine, Seoul National University HospitalAbstract Background Patients with diabetes mellitus (DM) have a higher prevalence of heart failure (HF) than those without it. Approximately 40 % of HF patients have DM and they tend to have poorer outcomes than those without DM. This study evaluated the impact of insulin therapy on mortality among acute HF patients. Methods A total of 1740 patients from the Korean Acute Heart Failure registry with DM were included in this study. The risk of all-cause mortality according to insulin therapy was assessed using the Cox proportional hazard models with inverse probability of treatment weighting to balance the clinical characteristics (pretreatment covariates) between the groups. Results DM patients had been treated with either oral hypoglycemic agents (OHAs) alone (n = 620), insulin alone (n = 682), or insulin combined with OHAs (n = 438). The insulin alone group was associated with an increased mortality risk compared with the OHA alone group (HR = 1.41, 95 % CI 1.21–1.66]). Insulin therapy combined with OHAs also showed an increased mortality risk (HR = 1.29, 95 % CI 1.14–1.46) compared with the OHA alone group. Insulin therapy was consistently associated with increased mortality risk, regardless of the left ventricular ejection fraction (LVEF) or HF etiology. A significant increase in mortality was observed in patients with good glycemic control (HbA1c < 7.0 %) receiving insulin, whereas there was no significant association in patients with poor glycemic control (HbA1c ≥ 7.0%). Conclusions Insulin therapy was found to be associated with increased mortality compared to OHAs. The insulin therapy was harmful especially in patients with low HbA1c levels which may suggest the necessity of specific management strategies and blood sugar targets when using insulin in patients with HF.https://doi.org/10.1186/s12933-021-01370-yInsulinDiabetes mellitusHeart failureMortality |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Se Yong Jang Jieun Jang Dong Heon Yang Hyun-Jai Cho Soo Lim Eun-Seok Jeon Sang Eun Lee Jae-Joong Kim Seok-Min Kang Sang Hong Baek Myeong-Chan Cho Dong-Ju Choi Byung-Su Yoo Kye Hun Kim Sue K. Park Hae-Young Lee |
spellingShingle |
Se Yong Jang Jieun Jang Dong Heon Yang Hyun-Jai Cho Soo Lim Eun-Seok Jeon Sang Eun Lee Jae-Joong Kim Seok-Min Kang Sang Hong Baek Myeong-Chan Cho Dong-Ju Choi Byung-Su Yoo Kye Hun Kim Sue K. Park Hae-Young Lee Impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus Cardiovascular Diabetology Insulin Diabetes mellitus Heart failure Mortality |
author_facet |
Se Yong Jang Jieun Jang Dong Heon Yang Hyun-Jai Cho Soo Lim Eun-Seok Jeon Sang Eun Lee Jae-Joong Kim Seok-Min Kang Sang Hong Baek Myeong-Chan Cho Dong-Ju Choi Byung-Su Yoo Kye Hun Kim Sue K. Park Hae-Young Lee |
author_sort |
Se Yong Jang |
title |
Impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus |
title_short |
Impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus |
title_full |
Impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus |
title_fullStr |
Impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus |
title_full_unstemmed |
Impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus |
title_sort |
impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus |
publisher |
BMC |
series |
Cardiovascular Diabetology |
issn |
1475-2840 |
publishDate |
2021-09-01 |
description |
Abstract Background Patients with diabetes mellitus (DM) have a higher prevalence of heart failure (HF) than those without it. Approximately 40 % of HF patients have DM and they tend to have poorer outcomes than those without DM. This study evaluated the impact of insulin therapy on mortality among acute HF patients. Methods A total of 1740 patients from the Korean Acute Heart Failure registry with DM were included in this study. The risk of all-cause mortality according to insulin therapy was assessed using the Cox proportional hazard models with inverse probability of treatment weighting to balance the clinical characteristics (pretreatment covariates) between the groups. Results DM patients had been treated with either oral hypoglycemic agents (OHAs) alone (n = 620), insulin alone (n = 682), or insulin combined with OHAs (n = 438). The insulin alone group was associated with an increased mortality risk compared with the OHA alone group (HR = 1.41, 95 % CI 1.21–1.66]). Insulin therapy combined with OHAs also showed an increased mortality risk (HR = 1.29, 95 % CI 1.14–1.46) compared with the OHA alone group. Insulin therapy was consistently associated with increased mortality risk, regardless of the left ventricular ejection fraction (LVEF) or HF etiology. A significant increase in mortality was observed in patients with good glycemic control (HbA1c < 7.0 %) receiving insulin, whereas there was no significant association in patients with poor glycemic control (HbA1c ≥ 7.0%). Conclusions Insulin therapy was found to be associated with increased mortality compared to OHAs. The insulin therapy was harmful especially in patients with low HbA1c levels which may suggest the necessity of specific management strategies and blood sugar targets when using insulin in patients with HF. |
topic |
Insulin Diabetes mellitus Heart failure Mortality |
url |
https://doi.org/10.1186/s12933-021-01370-y |
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