Relationship between the early initiation of insulin treatment and diabetic complications in patients newly diagnosed with type 2 diabetes mellitus in Korea: A nationwide cohort study

Abstract

Aims/introduction: To evaluate the relationship between early insulin initiation within a year after type 2 diabetes mellitus diagnosis and the risk of diabetic complications.

Materials and methods: We carried out a cohort study using the Korean National Health Insurance Service database. The study participants were newly diagnosed with type 2 diabetes mellitus between 2009 and 2013. After applying propensity score matching (1:1) to the cohort of patients who received two or more oral antidiabetic drugs (OADs) or insulin as the first prescription within 1 year after type 2 diabetes mellitus diagnosis, we computed hazard ratios (HRs) and 95% confidence intervals (CIs) using a Cox proportional hazards regression to compare the risk of diabetes-related microvascular and macrovascular complications and all-cause mortality in insulin versus OAD initiators.

Results: Within the cohort, 52,188 and 1,804 patients received OAD and insulin, respectively. After matching, each group contained 534 patients. Compared with the OAD group, the risk of overall microvascular complications was significantly higher for insulin (HR 1.48, 95% CI 1.28-1.71). No increased risks of overall macrovascular complications (HR 0.90, 95% CI 0.62-1.30) and all-cause mortality were observed (HR 1.06, 95% CI 0.67-1.68).

Conclusions: In the present study, early insulin treatment was not associated with the risk of macrovascular complications and all-cause mortality compared with OAD treatment; however, the risk of microvascular complications was higher in the insulin group.

Keywords: Diabetic complications; Insulin; Oral antidiabetic drug.

Figure 1

Flow chart for the selection of the study population. OAD, oral antidiabetic drug; GDM, gestational diabetes mellitus.

Figure 2

Kaplan–Meier curves and adjusted hazard ratios of the main analysis (≥2 oral antidiabetic drugs [OAD] group vs insulin group for the propensity score‐matched cohort) for (a) overall microvascular complications, (b) overall macrovascular complications and (c) all‐cause mortality.

Figure 3

Subgroup analysis of overall microvascular and macrovascular complications and all‐cause mortality among patients who received early insulin treatment compared with those who received oral antidiabetic drugs. CI, confidence interval; DPP4i, dipeptidyl peptidase‐4 inhibitor; HR, hazard ratio; MET, metformin; OAD, oral antidiabetic drug; SAI, short‐acting insulin; SU, sulfonylurea; TZD, thiazolidinedione.