Insulin resistance and cardiovascular outcomes in the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial
Diabetes, Obesity and Metabolism Sep 15, 2017
Gerstein HC, et al. - Analysts conducted a clinical study which showed that insulin resistance may not promote cardiovascular outcomes in people with dysglycemia. Methods
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- Analysts conducted self-titration of insulin doses targeting a fasting plasma glucose < 5.3 mmol/l (95 mg/dl) at every visit and cardiovascular and other serious health outcomes were ascertained.
- For this study, all analyses were restricted to participants allocated to insulin glargine, who added it to lifestyle or 1 glucose lowering oral agent at randomization.
- They characterized normoglycemia as a fasting plasma glucose <5.6 mmol/L and HbA1c <6% at the 2 year visit.
- Thereafter, the median of the natural logarithm of the insulin doses (expressed per kg of fat-free mass) recorded at every visit from randomization until either the penultimate visit or the first occurrence of a cardiovascular outcome was analyzed.
- The data showed that higher median insulin doses did not reflect incident cardiovascular events overall or in the subset that achieved normoglycemia.
- They exhibited evidence that when the dose taken before a cardiovascular event or the penultimate visit was analyzed, the adjusted hazard of the composite of cardiovascular death, myocardial infarction or stroke was 0.94 (95%CI 0.88, 1.00) per unit higher dose overall, and 0.91 (95%CI 0.81, 1.01) in the normoglycemic subset.
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