First Author: J.Lin TAIWAN
Co Author(s): M.S. Lai 0 0 0 0 0 0 0 0 0
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To investigate the association of long-acting insulin analogue use with the risk of progression of diabetic retinopathy in type 2 diabetes
A retrospective cohort study design was implemented using data from Taiwan’s National Health Insurance Research Database between January 2004 and December 2008. All initiators of insulin from July 1, 2004, through December 31, 2007, were identified. Patients were separated into two treatment regimen groups: long-acting insulin analogue therapy and intermediate -acting human insulin (HI) therapy. Exclusive users were followed from the date of insulin initiation to the earliest of development of sight-threatening diabetic retinopathy, death, disenrollment, or December 31 2008. We estimated adjusted hazard ratios and 95% confidence intervals (CIs) with Cox proportional hazards models adjusting for time-varying use of concomitant medications during the follow-up period in propensity score matched cohorts.
The incidence rate of sight threatening diabetic retinopathy per 1,000 person-years was 21.34 for long-acting insulin analogue initiators and 35.80 for intermediate -acting HI initiators during an average follow-up of 1.7 years. The incidence rate ratio of sight threatening diabetic retinopathy of long-acting insulin analogue use as compared with intermediate -acting HI was 0.73 (95% CI 0.39-1.39). No statistically significant difference in risk of progression of diabetic retinopathy between long-acting insulin analogue initiators and intermediate -acting HI initiators was found. The adjusted hazard ratio of long-acting insulin analogue use as compared with intermediate -acting HI was 0.70 (95% CI 0.39–1.25) and 0.75 (95% CI 0.39–1.47) according to two different analytic methods.
Long-acting insulin analogue use is not associated with a lower incidence of sight threatening diabetic retinopathy in Type 2 Diabetes as compared with intermediate -acting HI. Additional observational studies and randomized trials of long-acting insulin analogue for prevention of progression of diabetic retinopathy are warranted.