eprintid: 158725 rev_number: 26 eprint_status: archive userid: 34933 dir: disk0/00/15/87/25 datestamp: 2018-03-12 10:07:56 lastmod: 2022-02-16 12:26:13 status_changed: 2018-03-12 10:07:56 type: article metadata_visibility: show creators_name: Cosmi, Franco creators_name: Shen, Li creators_name: Magnoli, Michela creators_name: Abraham, William T. creators_name: Anand, Inder S. creators_name: Cleland, John G. creators_name: Cohn, Jay N. creators_name: Cosmi, Deborah creators_name: De Berardis, Giorgia creators_name: Dickstein, Kenneth creators_name: Franzosi, Maria Grazia creators_name: Gullestad, Lars creators_name: Jhund, Pardeep S. creators_name: Kjekshus, John creators_name: Køber, Lars creators_name: Lepore, Vito creators_name: Lucisano, Giuseppe creators_name: Maggioni, Aldo P. creators_name: Masson, Serge creators_name: McMurray, John J.V. creators_name: Nicolucci, Antonio creators_name: Petrarolo, Vito creators_name: Robusto, Fabio creators_name: Staszewsky, Lidia creators_name: Tavazzi, Luigi creators_name: Teli, Roberto creators_name: Tognoni, Gianni creators_name: Wikstrand, John creators_name: Latini, Roberto creators_orcid: 0000-0002-1471-7016 creators_orcid: 0000-0003-4306-5317 creators_orcid: 0000-0002-6317-3975 title: Treatment with insulin is associated with worse outcome in patients with chronic heart failure and diabetes ispublished: pub subjects: R1 divisions: 25200000 divisions: 25606000 full_text_status: public abstract: Aims: Up to one-third of patients with diabetes mellitus and heart failure (HF) are treated with insulin. As insulin causes sodium retention and hypoglycaemia, its use might be associated with worse outcomes. Methods and results: We examined two datasets: 24 012 patients with HF from four large randomized trials and an administrative database of 4 million individuals, 103 857 of whom with HF. In the former, survival was examined using Cox proportional hazards models adjusted for baseline variables and separately for propensity scores. Fine–Gray competing risk regression models were used to assess the risk of hospitalization for HF. For the latter, a case–control nested within a population-based cohort study was conducted with propensity score. Prevalence of diabetes mellitus at study entry ranged from 25.5% to 29.5% across trials. Insulin alone or in combination with oral hypoglycaemic drugs was prescribed at randomization to 24.4% to 34.5% of the patients with diabetes. The rates of death from any cause and hospitalization for HF were higher in patients with vs. without diabetes, and highest of all in patients prescribed insulin [propensity score pooled hazard ratio for all-cause mortality 1.27 (1.16–1.38), for HF hospitalization 1.23 (1.13–1.33)]. In the administrative registry, insulin prescription was associated with a higher risk of all-cause death [odds ratio (OR) 2.02, 95% confidence interval (CI) 1.87–2.19] and rehospitalization for HF (OR 1.42, 95% CI 1.32–1.53). Conclusions: Whether insulin use is associated with poor outcomes in HF should be investigated further with controlled trials, as should the possibility that there may be safer alternative glucose-lowering treatments for patients with HF and type 2 diabetes mellitus. date: 2018-05 date_type: published publication: European Journal of Heart Failure volume: 20 number: 5 publisher: Wiley pagerange: 888-895 id_number: 10.1002/ejhf.1146 refereed: TRUE issn: 1388-9842 copyright_holders: Copyright © 2018 The Authors and European Society of Cardiology prior: First published in European Journal of Heart Failure 20(5):888-895 repro: Reproduced in accordance with the publisher copyright policy uniqueid: glaseprints:2018-158725 issn_online: 1879-0844 pubmed_id: 29488676 euro_pubmed_id: 29488676 hoa_compliant: 511 hoa_emb_len: 12 hoa_ref_pan: AB hoa_date_acc: 2018-01-08 hoa_date_pub: 2018-02-28 hoa_date_foa: 2019-03-06 hoa_version_fcd: AM hoa_exclude: FALSE hoa_gold: FALSE oa_research_materials_ack: Yes rioxx2_apc_input: not required citation: Cosmi, F. et al. (2018) Treatment with insulin is associated with worse outcome in patients with chronic heart failure and diabetes. European Journal of Heart Failure , 20(5), pp. 888-895. (doi: 10.1002/ejhf.1146 ) (PMID:29488676) document_url: https://eprints.gla.ac.uk/158725/13/158725.pdf