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Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,118
Online ISSN 1827-1634
Filipe M. CUNHA 1, Pedro MARQUES 2, Joana PEREIRA 2, Maria J. PINTO 2, Pedro RODRIGUES 2, Helena MOREIRA 2, Patrícia LOURENÇO 2, Paulo BETTENCOURT 2, 3
1 Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar de São João, Porto, Portugal; 2 Serviço de Medicina Interna do Centro Hospitalar de São João, Porto, Portugal 3 Faculdade de Medicina da Universidade do Porto, Porto, Portugal
BACKGROUND: Diabetic patients with heart failure (HF) treated with insulin appear to have a worse prognosis compared to oral anti-diabetic (OAD) agents. Whether insulin is a risk factor or a marker of disease severity is unknown. We studied the prognostic impact of insulin treatment in an acute HF diabetic population.
METHODS: From a prospectively recruited population of hospital-admitted acute HF patients we retrospectively selected a convenience sample. Pair-matched analysis: each insulin-treated patient was matched with a diabetic patient with similar glycated haemoglobin (HbA1c±0.2%) under OAD. End-point: all-cause death. Follow-up: 5 years. Insulin-treated and OAD-treated patients were compared. Multivariate Cox- regression analysis was used to analyse the prognostic impact of insulin.
RESULTS: We studied 92 patients: 46 insulin-treated and 46 HbA1c-matched under OAD. Mean age: 74±9 years, 46.7% male and 63.5% had HF with reduced ejection fraction. HbA1c was 7.8±1.5% in both groups. In the subgroup under OAD: 87.0% metformin, 41.3% sulphonylurea, 28.3% dipeptidyl peptidase-4 inhibitors and 4.3% other agents. Insulin-treated patients had lower haemoglobin, higher creatinine and discharged B-type natriuretic peptide (BNP) levels [816.6(289.2-1805.8) vs. 613.3(205.6-1110.8); p=0.02]. Seventy three patients died. There were no differences in mortality up to 5 years. After multivariate adjustment accounting for haemoglobin, creatinine and discharge BNP, HR for 1-, 2-, 3-, and 5-year all-cause death in insulin- treated patients’ were 1.48(0.62-3.54); p=0.38, 1.11(0.55-2.25); p=0.77, 1.08(0.56- 2.08); p=0.28 and 1.24(0.70-2.19); p=0.46, respectively.
CONCLUSIONS: Insulin-treated diabetic patients with HF and HbA1c-matched patients treated with OAD have similarly ominous prognosis. Ours results favor insulin as a marker of poor health condition.