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Cardiovasc Diabetol: What should I do?Insulin therapy increases the risk of death of diabetic patients with heart failure!

Compared with ordinary people, diabetes (DM) patients often have higher incidence of heart failure (HF). About 40%of patients with heart failure are combined with diabetes, and the prognosis of these patients is worse than patients who do not combine diabetes. This study aims to evaluate the impact of insulin therapy on the mortality of patients with acute heart failure.

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A total of 1740 patients with diabetes from South Korea’s acute heart failure registry. The COX proportional risk model evaluation is based on the risk of death according to the risk of insulin therapy or not, and the clinical characteristics of each group are used to balance the counter -probability of the treatment of weighted weighted.

According to the type of hypoglycemic treatment, the patients were divided into a simple hypoglycemic drug treatment group (OHA, N = 620), a simple insulin therapy group (n = 682) or an insulin combined OHA treatment group (n = 438). Compared with the simple hypoglycemic drug treatment group, the risk of death of patients with the treatment group of the simple insulin treatment group (HR 1.41, 95% CI 1.21-1.66). The risk of death in the treatment group of insulin combined with hypoglycemic drugs has also increased compared to the simple hypoglycemic drug treatment group (HR 1.29, 95% CI 1.14-1.46).

Regardless of whether the patient has a reduction in a left ventricular ejection score or the cause of heart failure, insulin therapy is always related to the increase in the risk of death in the test patient. Researchers have observed that the mortality of patients with good blood glucose control (HBA1C <7.0 %) with insulin treatment has increased significantly, but there is no significant correlation in patients with poor blood glucose control (HBA1C ≥ 7.0 %).

In summary, the study found that insulin therapy is related to the increase in mortality of patients with diabetes combined with heart failure. Insulin therapy is particularly harmful to patients with low levels of HBA1C, indicating that patients with diabetic patients with heart failure require special management strategies and blood glucose targets when using insulin treatment.

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Primitive source:

Jang, S.Y., Jang, J., Yang, D.H. et al. Impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus. Cardiovasc Diabetol 20, 180 (2021). https://doi.org/10.1186/ s12933-021-01370-y

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