Comparison of Incidence of Acute Myocardial Infarction in Patients With Type 2 Diabetes Mellitus Following Initiation of Neutral Protamine Hagedorn Insulin Versus Insulin Glargine

George Rhoads, Mikhail Kosiborod, Richard W. Nesto, Vivian A. Fonseca, Shou-En Lu, Quanwu Zhang, Joanne M. Foody

Research output: Contribution to journalArticle

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Abstract

Recent reports have described different risks of acute myocardial infarction (AMI) in association with specific oral antidiabetic medications. The present study compared the AMI incidence rates in new users of traditional neutral protamine Hagedorn (NPH) insulin and a long-acting synthetic insulin analog for basal insulin therapy. We retrospectively examined in-patient medical claims for AMI in a cohort of oral agent-treated patients with type 2 diabetes mellitus after the initiation of basal insulin therapy with either NPH (n = 5,461) or insulin glargine (n = 14,730) in a national administrative claims database comprising >30 managed healthcare plans in the United States. Poisson regression and Cox proportional hazards regression models, as well as the propensity score methods, were used to compare the subsequent AMI incidence rates after the initiation of NPH or glargine. At a mean follow-up of 2 years, the unadjusted AMI incidence was 17.6/1,000 person-years after the initiation of NPH versus 11.5/1,000 person-years after initiation of glargine (rate ratio 1.53, 95% confidence interval 1.29 to 1.81). The Cox regression model (hazard ratio 1.39, 95% confidence interval 1.14 to 1.69) and sensitivity analyses (hazard ratio range 1.30 to 1.56) showed a greater risk of AMI in the NPH group than in the glargine group. Propensity matched (1:1) analysis yielded similar results (odds ratio 1.55, 95% confidence interval 1.23 to 1.96 for NPH vs glargine). In conclusion, these results suggest that the initiation of basal insulin therapy with NPH rather than glargine in patients with type 2 diabetes mellitus is associated with a greater risk of AMI.

Original languageEnglish (US)
Pages (from-to)910-916
Number of pages7
JournalAmerican Journal of Cardiology
Volume104
Issue number7
DOIs
StatePublished - Oct 1 2009

Fingerprint

Isophane Insulin
Protamines
Type 2 Diabetes Mellitus
Myocardial Infarction
Incidence
Confidence Intervals
Insulin
Proportional Hazards Models
Long-Acting Insulin
Propensity Score
Proxy
Insulin Glargine
Hypoglycemic Agents
Therapeutics
Odds Ratio
Databases
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Rhoads, George ; Kosiborod, Mikhail ; Nesto, Richard W. ; Fonseca, Vivian A. ; Lu, Shou-En ; Zhang, Quanwu ; Foody, Joanne M. / Comparison of Incidence of Acute Myocardial Infarction in Patients With Type 2 Diabetes Mellitus Following Initiation of Neutral Protamine Hagedorn Insulin Versus Insulin Glargine. In: American Journal of Cardiology. 2009 ; Vol. 104, No. 7. pp. 910-916.
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abstract = "Recent reports have described different risks of acute myocardial infarction (AMI) in association with specific oral antidiabetic medications. The present study compared the AMI incidence rates in new users of traditional neutral protamine Hagedorn (NPH) insulin and a long-acting synthetic insulin analog for basal insulin therapy. We retrospectively examined in-patient medical claims for AMI in a cohort of oral agent-treated patients with type 2 diabetes mellitus after the initiation of basal insulin therapy with either NPH (n = 5,461) or insulin glargine (n = 14,730) in a national administrative claims database comprising >30 managed healthcare plans in the United States. Poisson regression and Cox proportional hazards regression models, as well as the propensity score methods, were used to compare the subsequent AMI incidence rates after the initiation of NPH or glargine. At a mean follow-up of 2 years, the unadjusted AMI incidence was 17.6/1,000 person-years after the initiation of NPH versus 11.5/1,000 person-years after initiation of glargine (rate ratio 1.53, 95{\%} confidence interval 1.29 to 1.81). The Cox regression model (hazard ratio 1.39, 95{\%} confidence interval 1.14 to 1.69) and sensitivity analyses (hazard ratio range 1.30 to 1.56) showed a greater risk of AMI in the NPH group than in the glargine group. Propensity matched (1:1) analysis yielded similar results (odds ratio 1.55, 95{\%} confidence interval 1.23 to 1.96 for NPH vs glargine). In conclusion, these results suggest that the initiation of basal insulin therapy with NPH rather than glargine in patients with type 2 diabetes mellitus is associated with a greater risk of AMI.",
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Comparison of Incidence of Acute Myocardial Infarction in Patients With Type 2 Diabetes Mellitus Following Initiation of Neutral Protamine Hagedorn Insulin Versus Insulin Glargine. / Rhoads, George; Kosiborod, Mikhail; Nesto, Richard W.; Fonseca, Vivian A.; Lu, Shou-En; Zhang, Quanwu; Foody, Joanne M.

In: American Journal of Cardiology, Vol. 104, No. 7, 01.10.2009, p. 910-916.

Research output: Contribution to journalArticle

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