胰岛素暴露水平可以增加心血管疾病死亡率

在近日召开的美国ADA年会中，来自天普大学医学院，内分泌科的Elias S等人发表了一项研究结果，该研究结果表示，胰岛素暴露水平可能会增加2型胰岛素患者心血管疾病的发病率和死亡率。

该研究组发现在ACCORD实验中，针对具有心血管疾病风险的2型糖尿病患者进行强化治疗，可以导致更高的心血管疾病(CV)风险和死亡率。之前的研究分析结论显示低血糖、血糖的快速降低和一些特殊药物与CV无明显联系。所以该研究组假设在治疗过程中注入高剂量的胰岛素的暴露水平可以增加CV的死亡率。全组共跟踪随访了10163例患者5年的胰岛素暴露。使用Cox回归模型来分析胰岛素暴露水平和CV死亡率之间的关系（更新每日的基础和餐前胰岛素平均剂量 U/kg）。结果显示一系列模型呈上升趋势，包括基线变量值和后基线协助变量值

在单变量分析中，CV死亡率和胰岛素显露水平显著相关，基线调整后，两者联系不再显著，其他协变量如A1c和低血糖影响较小。

In the ACCORD trial intensive treatment of type 2 diabetes patients with high cardiovascular (CV) risk led to higher all-cause and CV mortality.  Post-hoc analyses have not yet conclusively implicated hypoglycemia rapid reduction of glucose or specific drugs. We hypothesized that exposure to high doses of injected insulin might have contributed to increased CV mortality.

We looked at insulin exposure data of 10 163 subjects with a mean follow-up of 5 years. Cox proportional hazards models were used to examine associations between CV mortality and insulin exposure (updated average daily dosage [units/kg]) of all basal and prandial insulin).  A series of models were developed that incorporated an increasing number of baseline and post baseline covariates.

In univariate analysis insulin exposure was associated with increased CV mortality. After adjustment for baseline characteristics these associations were no longer statistically significant. Addition of other covariates including A1c and hypoglycemia had little effect (Table).

编辑： 吴楠    来源：丁香园