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A propensity score matched comparison of different insulin regimens 1 year after beginning insulin in people with type 2 diabetes

Lookup NU author(s): Emeritus Professor Philip Home

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Abstract

AimTo compare using propensity score analysis the outcome of beginning insulin therapy with basal, premix, mealtime+basal or mealtime insulin on the basis of data from 3031 people from the observational CREDIT (Cardiovascular Risk Evaluation in People with Type 2 Diabetes on Insulin Therapy) study. This approach overcomes likely confounding in baseline and unknown characteristics common to observational studies.MethodsEfficacy and safety outcomes were collected at baseline and at 1year in previously insulin-naive people. Propensity score matched groups using all available baseline data were defined to compare outcomes by pairs of insulin regimens.ResultsFrom 2659 people with available data, propensity score matches were achieved for 686 people starting premix or basal insulin, 542 starting basal+mealtime or premix insulin and 400 starting basal or basal+mealtime. HbA1c reduction did not differ between the three pairs of insulin regimens. However, the relative risk of overall and nocturnal hypoglycaemia was lower (p=0.010 to p<0.001) with basal or basal+mealtime compared with premix insulin, and for nocturnal (p=0.021) but not overall hypoglycaemia for basal compared to basal+mealtime insulin. Body weight increase was less for basal versus premix insulin [-1.3 (95% CI -2.1, -0.6) kg, p<0.001] or versus basal+mealtime insulin [-1.4 (-2.5, -0.3) kg, p=0.016], but did not differ between basal+mealtime and premix. Smaller groups matching mealtime insulin had some residual mismatching of HbA1c.ConclusionComparing insulin regimens between individuals matched by propensity scores indicated differences in hypoglycaemia and body weight change, despite similar HbA1c reductions. Our findings are consistent with those from randomized controlled trials.

Publication metadata

Author(s): Freemantle N, Balkau B, Home PD

Publication type: Article

Publication status: Published

Journal: Diabetes, Obesity and Metabolism

Year: 2013

Volume: 15

Issue: 12

Pages: 1120-1127

Print publication date: 01/12/2013

Online publication date: 16/07/2013

Acceptance date: 11/06/2013

Date deposited: 03/11/2014

ISSN (print): 1462-8902

ISSN (electronic): 1463-1326

Publisher: Wiley-Blackwell

URL: http://dx.doi.org/10.1111/dom.12147

DOI: 10.1111/dom.12147

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