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Minerva Endocrinologica 2016 Oct 28

lingua: Inglese

Insulin treatment may not be associated with worse prognosis in acute heart failure diabetic patients

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.

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