All-Cause and Cardiovascular Mortality Among Insulin-Naive People With Type 2 Diabetes Treated With Insulin Detemir or Glargine: A Cohort Study in the UK

Introduction Uncontrolled type 2 diabetes (T2D) is associated with an increased risk of micro- and macrovascular complications and mortality. The impact of basal insulins on the risks of mortality and cardiovascular mortality in people with T2D has not been thoroughly investigated in real-world settings. The aim of the present real-word study was to investigate differences in mortality among insulin-naive people with T2D who initiated insulin detemir (detemir) and insulin glargine (glargine). Methods We assessed all-cause and cardiovascular mortality in people with T2D, aged >= 40 years and insulin-naive at treatment initiation. People were identified from the United Kingdom Clinical Practice Research Datalink GOLD national database (2004-2019). Database information included prescribed medications, demographic and clinical variables and mortality. Cause of death was obtained from the Office for National Statistics (ONS). For mortality, 24 clinically relevant confounders were considered and adjusted for using Cox regression analyses. Results The total cohort included 12,847 people with T2D, including 3031 who commenced detemir and 9816 who commenced glargine. Median age was 66.8 years and median diabetes duration was 7.6 years. From the total cohort, 3231 deaths occurred during follow-up and 6897 people were eligible for linkage to the ONS for cardiovascular mortality data (528 cardiovascular deaths). The adjusted hazard ratio (HR) (95% confidence interval [CI]) was 0.86 (0.79; 0.95) for all-cause mortality and 0.83 (0.67; 1.03) for cardiovascular mortality, in favour of detemir versus glargine. These associations were more pronounced among people with obesity (body mass index >= 30 kg/m(2)), with HRs (95% CI) of 0.79 (0.69; 0.91) and 0.69 (0.50; 0.96) for all-cause and cardiovascular mortality, respectively. Conclusion In this real-world observational study, there was an association between all-cause mortality and basal insulin choice in insulin-naive people with T2D; the mortality risk was lower with detemir versus glargine after adjustment for potential confounders.

Automated summary

In this real-world study, the choice of basal insulin in insulin-naive people with T2D was associated with all-cause mortality, with a lower mortality risk observed with detemir compared to glargine after adjusting for potential confounders. This association was more pronounced in individuals with obesity.