Patients with diabetes mellitus (DM) have a higher prevalence of heart failure (HF) than those without it. Approximately 40 % of HF patients have DM and they tend to have poorer outcomes than those without DM. This study evaluated the impact of insulin therapy on mortality among acute HF patients. A total of 1740 patients from the Korean Acute Heart Failure registry with DM were included in this study. The risk of all-cause mortality according to insulin therapy was assessed using the Cox proportional hazard models with inverse probability of treatment weighting to balance the clinical characteristics (pretreatment covariates) between the groups. DM patients had been treated with either oral hypoglycemic agents (OHAs) alone (n = 620), insulin alone (n = 682), or insulin combined with OHAs (n = 438). The insulin alone group was associated with an increased mortality risk compared with the OHA alone group (HR = 1.41, 95 % CI 1.21–1.66]). Insulin therapy combined with OHAs also showed an increased mortality risk (HR = 1.29, 95 % CI 1.14–1.46) compared with the OHA alone group. Insulin therapy was consistently associated with increased mortality risk, regardless of the left ventricular ejection fraction (LVEF) or HF etiology. A significant increase in mortality was observed in patients with good glycemic control (HbA1c < 7.0 %) receiving insulin, whereas there was no significant association in patients with poor glycemic control (HbA1c ≥ 7.0%). Insulin therapy was found to be associated with increased mortality compared to OHAs. The insulin therapy was harmful especially in patients with low HbA1c levels which may suggest the necessity of specific management strategies and blood sugar targets when using insulin in patients with HF.

中文翻译：

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胰岛素治疗对糖尿病急性心力衰竭患者死亡率的影响


糖尿病（DM）患者的心力衰竭（HF）患病率高于非糖尿病患者。大约 40% 的心力衰竭患者患有糖尿病，他们的预后往往比没有糖尿病的患者差。本研究评估了胰岛素治疗对急性心力衰竭患者死亡率的影响。本研究共纳入 1740 名来自韩国急性心力衰竭登记处的 DM 患者。使用 Cox 比例风险模型评估胰岛素治疗导致的全因死亡风险，并使用治疗加权的逆概率来平衡各组之间的临床特征（治疗前协变量）。 DM 患者接受单独口服降糖药 (OHA) (n = 620)、单独胰岛素 (n = 682) 或胰岛素联合 OHA (n = 438) 的治疗。与单独使用 OHA 组相比，单独使用胰岛素组与死亡风险增加相关（HR = 1.41，95% CI 1.21–1.66]）。与单独使用 OHA 组相比，胰岛素联合 OHA 治疗也显示死亡风险增加（HR = 1.29，95 % CI 1.14–1.46）。无论左心室射血分数 (LVEF) 或心力衰竭病因如何，胰岛素治疗始终与死亡风险增加相关。在接受胰岛素治疗的血糖控制良好（HbA1c < 7.0 %）的患者中观察到死亡率显着增加，而在血糖控制不佳（HbA1c ≥ 7.0%）的患者中则没有显着相关性。与 OHA 相比，胰岛素治疗被发现与死亡率增加相关。胰岛素治疗是有害的，尤其是对于 HbA1c 水平低的患者，这可能表明在心衰患者使用胰岛素时有必要采取特定的管理策略和血糖目标。