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Minerva Endocrinologica 2017 December;42(4):318-24

DOI: 10.23736/S0391-1977.16.02535-9

Copyright © 2016 EDIZIONI MINERVA MEDICA

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 Department of Endocrinology, Diabetes and Metabolism, Hospital of São João, Porto, Portugal; 2 Department of Internal Medicine, Hospital of São João, Porto, Portugal; 3 Faculty of Medicine, University of Porto, Porto, Portugal


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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 hemoglobin (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 analyze 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 hemoglobin, 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 hemoglobin, 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. Our results favor insulin as a marker of poor health condition.


KEY WORDS: Heart failure - Insulin - Diabetes mellitus - Prognosis

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Publication History

Issue published online: September 15, 2017
Article first published online: October 28, 2016
Manuscript accepted: October 19, 2016
Manuscript revised: September 27, 2016
Manuscript received: July 5, 2016

Per citare questo articolo

Cunha FM, Marques P, Pereira J, Pinto MJ, Rodrigues P, Moreira H, et al. Insulin treatment may not be associated with worse prognosis in acute heart failure diabetic patients. Minerva Endocrinol 2017;42:318-24. DOI: 10.23736/S0391-1977.16.02535-9

Corresponding author e-mail

filipemrcunha@gmail.com