Evaluation of the incidence and risk of hypoglycemic coma associated with selection of basal insulin in the treatment of diabetes: a Finnish register linkage study†
نویسندگان
چکیده
OBJECTIVE Long-acting basal insulin analogs have demonstrated positive effects on the balance between effective glycemic control and risk of hypoglycemia versus neutral protamine Hagedorn (NPH) insulin in randomized controlled trials. Evidence of severe hypoglycemic risk with insulin detemir, insulin glargine, or NPH insulin is presented from a nationwide retrospective database study. RESEARCH DESIGN AND METHODS Data from hospital and secondary healthcare visits due to hypoglycemic coma from 75 682 insulin-naïve type 1 or 2 diabetes patients initiating therapy with NPH insulin, insulin glargine, or insulin detemir in Finland between 2000 and 2009 were analyzed. Incidence rates with 95% confidence intervals (CIs) were calculated using Poisson regression. Hazard ratios were estimated using Cox's regression with adjustments for relevant background variables. RESULTS The adjusted risk of hospital/secondary healthcare visits due to the first severe hypoglycemic event was 21.7% (95% CI 9.6-32.1%, p < 0.001) lower for insulin detemir and 9.9% (95% CI 1.5-17.6%, p = 0.022) lower for insulin glargine versus NPH insulin. Risk of hypoglycemic coma recurrence was 36.3% (95% CI 8.9-55.5%, p = 0.014) lower for detemir and 9.5% but not significantly (95% CI -10.2 to 25.7%, p = 0.318) lower for glargine versus NPH insulin. Risk of all hypoglycemic coma events was 30.8% (95% CI 16.2-42.8%, p-value <0.001) lower for detemir and 15.6% (95% CI 5.1-25.0%, p-value 0.005) lower for glargine versus NPH. Insulin detemir had a significantly lower risk for first (13.1% lower [p = 0.034]), recurrent (29.6% lower [p = 0.021]), and all (17.9% lower [p = 0.016]) severe hypoglycemic events than insulin glargine. CONCLUSIONS There were considerable differences in risk of hospitalization or secondary healthcare visits due to hypoglycemic coma between basal insulin treatments in real-life clinical practice.
منابع مشابه
Therapeutic effects and mechanism of Teucrium polium in diabetes mellitus :a review article
Background and objectives: Amongst the serious metabolic disorders, diabetes mellitus (DM) is a common disease throughout the world. The excess of morbidity and mortality associated with DM and its complications emphasize the importance of new or alternative therapeutic strategies in prevention and treatment of this chronic disorder. Medicinal herbs grow vastly in Iran and are ...
متن کاملمقایسه بیماران مبتلا به دیابت پنهان خودایمن و دیابت نوع 1 از نظر سابقه خانوادگی دیابت
Background: Latent autoimmune diabetes of adults (LADA) is a form of autoimmune diabetes initially managed with oral hypoglycemic agents before becoming insulin requiring. One of the LADA risk factors is family history of diabetes (FHD) that less well understood. Our aim was investigate the influence of FHD on the incidence of LADA compared with those for type 1. Methods: In this cross section...
متن کاملSingle-nucleotide polymorphism of rs11061971 (+219 A>T) in adiponectin receptor 2 (AdipoR2) gene and its association with risk of type 2 diabetes among an Iranian population
Background and Objectives: Genetic modifications in the adiponectin receptor 2 (AdipoR2) gene can affect phenotypes associated with insulin resistance and diabetes. The purpose of this study was to evaluate the possible role of genetic modifications in the AdipoR2 gene, to determine the frequency of genotypes and polymorphism alleles of this gene at rs11061971 (+219 A>T), and to investigate its...
متن کاملNews About the Treatment of Diabetes with Insulin
One of the most important advances in imsulin therapy has been the commercial production of highly purified single peak and single component insulin. The routine use of these pre9ara -tions have reduced insulin allergy and abolished insulin lipoatrophy. The subject of low dose insulin infusion in diabetic keto - acidosis in still controversial,but is based on sound theoreti - cal and experim...
متن کاملHypoglycemic Effects of Three Medicinal Plants in Experimental Diabetes: Inhibition of Rat Intestinal α-glucosidase and Enhanced Pancreatic Insulin and Cardiac Glut-4 mRNAs Expression
Garlic (Allium sativum L., Alliaceae), Persian shallot (Allium ascalonicum L., Alliaceae ) and Sage (Salvia officinalis L., Lamiaceae) are believed to have hypoglycemic properties and have been used traditionally as antidiabetic herbal medicines in Iran. In this study, diabetes was induced by subcutaneous injection of alloxan monohydrate (100 mg kg−1) to male Wistar rats. Antidiabetic effects of...
متن کامل