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Long-acting insulin analogues and diabetic retinopathy: a retrospective cohort study
Jen-Chieh Lin1, Wen-Yi Shau2, Mei-Shu Lai3
1Department of Ophthalmology, Taipei City Hospital, Heping Fuyoy Branch, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Purpose:
Long-acting insulin analogues were developed to facilitate consistent glycemic control without excessive hypoglycemia. However, structural modifications of the insulin molecule can alter biological responses and binding characteristics with specific receptors. The aim of this study was to estimate the risk of sight-threatening diabetic retinopathy (STDR) associated with treatment using long-acting insulin analogues compared with intermediate-acting insulin in patients with type 2 diabetes mellitus (T2DM).
Methods:
A retrospective cohort consisting of patients with T2DM aged 20 years of age and older with newly initiated treatment with long-acting insulin analogues (glargine and detemir) and intermediate-acting human insulin was identified from the National Health Insurance database between January 2004 and December 2006 and was subdivided into different cohorts. The risk of the development of STDR was determined by Cox regression models and compared between different cohorts.
Findings:
Of the 46,739 eligible patients, initiators of insulin glargine, insulin detemir, and neutral protamine Hagedorn (NPH) insulin were identified for comparison using propensity-score matching methods. Long-acting insulin analogues were not associated with changed risk for STDR by intention-to-treat and time-varying use approaches between either matched or unmatched cohorts.
Implications:
The strategies that aim at preventing diabetic retinopathy by treating T2DM patients with long-acting insulin analogues remain further prospective studies with longer follow-up period to validate our observations within an appropriate dosage range and to further evaluate the safety of long-acting insulin analogues on reducing the progression of diabetic retinopathy.
Insights
Long-acting insulin analogues did not alter the risk of sight-threatening diabetic retinopathy (STDR) in type 2 diabetes mellitus (T2DM) patients compared to intermediate-acting insulin. Further studies are needed to confirm safety and efficacy in STDR prevention.
Area of Science:
- Endocrinology
- Ophthalmology
- Pharmacology
Background:
- Long-acting insulin analogues (LAIAs) were designed for improved glycemic control in type 2 diabetes mellitus (T2DM).
- Structural changes in LAIAs may affect receptor binding and biological responses.
- The potential impact of LAIAs on diabetic retinopathy progression requires investigation.
Purpose of the Study:
- To compare the risk of sight-threatening diabetic retinopathy (STDR) in T2DM patients treated with LAIAs versus intermediate-acting insulin.
- To assess the safety profile of insulin glargine and insulin detemir concerning STDR development.
Main Methods:
- Retrospective cohort study of T2DM patients (≥20 years) initiated on LAIAs (glargine, detemir) or neutral protamine Hagedorn (NPH) insulin.
- Data sourced from the National Health Insurance database (2004-2006).
- Cox regression models and propensity-score matching used to compare STDR risk between treatment groups.
Main Results:
- Analysis included 46,739 eligible patients, with propensity-score matched cohorts identified.
- No significant difference in STDR risk was observed between LAIA initiators and NPH insulin users.
- Both intention-to-treat and time-varying use analyses showed consistent findings regarding STDR risk.
Conclusions:
- Current evidence suggests LAIAs are not associated with an increased risk of STDR in T2DM patients.
- Prospective studies with longer follow-up are recommended to validate these findings.
- Further research should evaluate optimal dosage ranges and long-term safety of LAIAs for retinopathy prevention.
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