Abstract
Aim
We compared the effects of basal insulins: long-acting insulin analogues versus intermediate/long-acting human insulin, on diabetes-related complications in type 1 diabetes.
Methods
1,188 type 1 diabetes newly on long-acting insulin analogues or intermediate/long-acting human insulin were identified in 2004-2008 and followed until death or 2013. Clinical outcomes included acute (i.e., hyperglycemia, hypoglycemia) and chronic (i.e., nephropathy, retinopathy, neuropathy, cardiovascular diseases) complications. Diabetes-related complications were measured as a composite outcome which included acute and chronic complications. Cox proportional hazards models were used to assess the time to event hazard. Three propensity score (PS) methods were applied to adjust for baseline imbalances between basal insulin groups, including PS-matching approach (as main analysis), standardized mortality ratio weighting (SMRW), and inverse probability of treatment weighting (IPTW).
Results
Long-acting insulin analogues versus intermediate/long-acting human insulin had a lower risk for a composite of diabetes-related complications (adjusted hazards ratios; aHRs [95% CI]: 0.782 [0.639-0.956], 0.743 [0.598-0.924], and 0.699 [0.577-0.846] according to the PS-matching approach, SMRW, and IPTW, respectively). Compared to intermediate/long-acting human insulin, using long-acting insulin analogues had a lower hypoglycemia risk: aHRs (95% CI): 0.681 (0.498-0.930), 0.662 (0.466-0.943), and 0.639 (0.471-0.867) from PS-matching approach, SMRW, and IPTW, respectively. No statistical differences between two types of insulin on individual chronic complications were found.
Conclusion
A trend of lower diabetes-related complications associated with long-acting insulin analogues versus intermediate/long-acting human insulin was observed. Reduced hypoglycemia risk with long-acting insulin analogues was confirmed in this real-world study.
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