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Similar long-term morbidity and mortality with human insulin and analogue insulins
Clinical Question
Is there a difference in the long-term morbidity and mortality in adults with type 2 diabetes who are treated with human insulin versus analogue insulin?
Bottom line
This study found no difference in long-term patient-oriented outcomes between human and analogue insulins in adults with type 2 diabetes. Recent evidence also found no difference in the rates of severe hypoglycemia. The best evidence we have shows no proven benefit to using analogue insulins instead of the older human insulins, and potential harm because the higher cost of analogue insulins may prohibit patient acquisition. 2b
Reference
Study design: Cohort (retrospective)
Funding: Government
Setting: Population-based
Synopsis
These investigators analyzed data from 4 large integrated health care delivery systems in the United States, specifically identifying adults who filled a first insulin prescription from January 1, 2005, through December 31, 2013. Continuous treatment with the same insulin therapy was determined based on prescription refill dates. A total of 127,600 participants met eligibility criteria, including having type 2 diabetes and an initial date of insulin therapy. The individuals who assessed outcomes obtained vital statistics from hospital records, state registries, and national registries. Adjustments occurred in outcomes to control for potential confounders, including patient demographics, comorbid conditions, medication use, smoking, and socioeconomic variables. Adjusted hazard ratios for continuous exposure to analogue versus human insulin demonstrated no significant differences in all-cause mortality, mortality due to cardiovascular disease, myocardial infarction, and congestive heart failure hospitalization.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC