Treatment with Insulin is Associated with Worse Outcome in Patients with Chronic Heart Failure and Diabetes
Rattachement africain : gb, it, us, no, dk, nl, se. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
AIMS: Up to one-third of patients with diabetes mellitus and heart failure (HF) are treated with insulin. As insulin causes sodium retention and hypoglycaemia, its use might be associated with worse outcomes. METHODS AND RESULTS: We examined two datasets: 24 012 patients with HF from four large randomized trials and an administrative database of 4 million individuals, 103 857 of whom with HF. In the former, survival was examined using Cox proportional hazards models adjusted for baseline variables and separately for propensity scores. Fine-Gray competing risk regression models were used to assess the risk of hospitalization for HF. For the latter, a case-control nested within a population-based cohort study was conducted with propensity score. Prevalence of diabetes mellitus at study entry ranged from 25.5% to 29.5% across trials. Insulin alone or in combination with oral hypoglycaemic drugs was prescribed at randomization to 24.4% to 34.5% of the patients with diabetes. The rates of death from any cause and hospitalization for HF were higher in patients with vs. without diabetes, and highest of all in patients prescribed insulin [propensity score pooled hazard ratio for all-cause mortality 1.27 (1.16-1.38), for HF hospitalization 1.23 (1.13-1.33)]. In the administrative registry, insulin prescription was associated with a higher risk of all-cause death [odds ratio (OR) 2.02, 95% confidence interval (CI) 1.87-2.19] and rehospitalization for HF (OR 1.42, 95% CI 1.32-1.53). CONCLUSIONS: Whether insulin use is associated with poor outcomes in HF should be investigated further with controlled trials, as should the possibility that there may be safer alternative glucose-lowering treatments for patients with HF and type 2 diabetes mellitus.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Treatment with Insulin is Associated with Worse Outcome in Patients with Chronic Heart Failure and Diabetes
- Date Crossref
- 28/02/2018
- Éditeur
- Oxford University Press (OUP)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Glasgow BHF Cardiovascular Research Centre pays non établi dans la noticeUniversité ou école supérieure
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Mario Negri Institute for Pharmacological Research pays non établi dans la noticeOrganisation à but non lucratif
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Istituti di Ricovero e Cura a Carattere Scientifico pays non établi dans la noticeÉtablissement de santé
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University of Minnesota Division of Cardiovascular Medicine pays non établi dans la noticeUniversité ou école supérieure
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University of Minnesota Medical Center pays non établi dans la noticeÉtablissement de santé
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Minneapolis VA Medical Center Department of Cardiology pays non établi dans la noticeÉtablissement de santé
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Imperial College London pays non établi dans la noticeUniversité ou école supérieure
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Center for Outcomes Research and Clinical Epidemiology pays non établi dans la noticeOrganisation à but non lucratif
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Stavanger University Hospital pays non établi dans la noticeÉtablissement de santé
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University of Bergen pays non établi dans la noticeUniversité ou école supérieure
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Oslo University Hospital Department of Cardiology pays non établi dans la noticeÉtablissement de santé
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University of Oslo pays non établi dans la noticeUniversité ou école supérieure
BHF Cardiovascular Research Centre — University of Glasgow, Mario Negri Institute for Pharmacological Research et Istituti di Ricovero e Cura a Carattere Scientifico, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.