U Anyanwagu1, J Mamza1, R Donnelly1, I Idris2. 1. Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, United Kingdom. 2. Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, United Kingdom. Electronic address: iidris@aol.com.
Abstract
OBJECTIVES: To compare the cardiovascular and metabolic outcomes of Insulin versus non-insulin glucose lowering therapy (GLT). METHODS: We included randomised control trials (RCTs) which randomised patients aged >18years with Type 2 Diabetes (T2D) to insulin vs non-insulin GLT. We used risk ratios (RR), risk difference (RD) and odds ratios (OR) with 95% confidence interval (95%CI) to analyse the treatment effects of dichotomous outcomes and mean differences (with 95% CI) for continuous outcomes. RESULTS: We included 18 RCTs with 19,300 participants. There was no significant difference in the risk of all-cause mortality and CV events between the groups (RR=1.01; 95%CI: 0.96-1.06; p=0.69). In 16 trials, insulin showed greater efficacy in glycaemic control (mean diff=-0.20; 95%CI: -0.28 to -0.11) but the proportion achieving HbA1c level of either ⩽7.0% or 7.4% (53 or 57mmol/mol) was similar in both (OR=1.55; 95%CI=0.92-2.62). The non-insulin group had a significant reduction in weight (mean diff=-3.41; 95%CI: -4.50 to -2.32) and an increase in the proportion of adverse events (54.7% vs 45.3%, p=0.044), but the insulin group showed an (RR=1.90; 95%CI: 1.44-2.51) increased risk of hypoglycaemia. CONCLUSION: There was no difference in the risk of all-cause mortality and adverse cardiovascular (CV) events between Insulin and non-insulin GLTs. Insulin was associated with superior reduction in HbA1c; least reduction in weight and higher risk of hypoglycaemia. Both showed similar proportion of patients achieving HbA1c target. Non-insulin GLTs were associated with a higher risk in reported adverse drug events.
OBJECTIVES: To compare the cardiovascular and metabolic outcomes of Insulin versus non-insulinglucose lowering therapy (GLT). METHODS: We included randomised control trials (RCTs) which randomised patients aged >18years with Type 2 Diabetes (T2D) to insulin vs non-insulin GLT. We used risk ratios (RR), risk difference (RD) and odds ratios (OR) with 95% confidence interval (95%CI) to analyse the treatment effects of dichotomous outcomes and mean differences (with 95% CI) for continuous outcomes. RESULTS: We included 18 RCTs with 19,300 participants. There was no significant difference in the risk of all-cause mortality and CV events between the groups (RR=1.01; 95%CI: 0.96-1.06; p=0.69). In 16 trials, insulin showed greater efficacy in glycaemic control (mean diff=-0.20; 95%CI: -0.28 to -0.11) but the proportion achieving HbA1c level of either ⩽7.0% or 7.4% (53 or 57mmol/mol) was similar in both (OR=1.55; 95%CI=0.92-2.62). The non-insulin group had a significant reduction in weight (mean diff=-3.41; 95%CI: -4.50 to -2.32) and an increase in the proportion of adverse events (54.7% vs 45.3%, p=0.044), but the insulin group showed an (RR=1.90; 95%CI: 1.44-2.51) increased risk of hypoglycaemia. CONCLUSION: There was no difference in the risk of all-cause mortality and adverse cardiovascular (CV) events between Insulin and non-insulin GLTs. Insulin was associated with superior reduction in HbA1c; least reduction in weight and higher risk of hypoglycaemia. Both showed similar proportion of patients achieving HbA1c target. Non-insulin GLTs were associated with a higher risk in reported adverse drug events.
Authors: Marcello Casaccia Bertoluci; João Eduardo Nunes Salles; José Silva-Nunes; Hermelinda Cordeiro Pedrosa; Rodrigo Oliveira Moreira; Rui Manuel Calado da Silva Duarte; Davide Mauricio da Costa Carvalho; Fábio Rogério Trujilho; João Filipe Cancela Dos Santos Raposo; Erika Bezerra Parente; Fernando Valente; Fábio Ferreira de Moura; Alexandre Hohl; Miguel Melo; Francisco Garcia Pestana Araujo; Rosa Maria Monteiro Castro de Araújo Principe; Rosane Kupfer; Adriana Costa E Forti; Cynthia Melissa Valerio; Hélder José Ferreira; João Manuel Sequeira Duarte; José Francisco Kerr Saraiva; Melanie Rodacki; Maria Helane Costa Gurgel Castelo; Mariana Pereira Monteiro; Patrícia Quadros Branco; Pedro Manuel Patricio de Matos; Pedro Carneiro de Melo Pereira de Magalhães; Roberto Tadeu Barcellos Betti; Rosângela Roginski Réa; Thaisa Dourado Guedes Trujilho; Lana Catani Ferreira Pinto; Cristiane Bauermann Leitão Journal: Diabetol Metab Syndr Date: 2020-05-24 Impact factor: 3.320