Wamil, M., Coleman, R. L., Adler, A. I., McMurray, J. J.V. and Holman, R. R. (2021) Increased risk of incident heart failure and death is associated with insulin resistance in people with newly diagnosed type 2 diabetes: UKPDS 89. Diabetes Care, 44(8), pp. 1877-1884. (doi: 10.2337/dc21-0429) (PMID:34162666)
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Abstract
Objective: Insulin resistance (IR) may mediate heart failure (HF) development. We examined whether IR in people with newly diagnosed type 2 diabetes (T2D) increased their risk of a composite outcome of HF or death or of HF alone. Research Design and Methods: Insulin resistance (HOMA2-IR) values for UKPDS participants were derived from paired fasting plasma glucose (FPG) and insulin measures. Kaplan-Meier survival curves and multivariable survival models were used to evaluate associations between HOMA2-IR and HF/death or HF alone. We adjusted for potential confounders by including variables with univariate associations (P < 0.1) and by requiring a multivariable P < 0.05. Results: Of 5,102 UKPDS participants with newly diagnosed T2D, 4,344 had HOMA2-IR measurements. At enrollment, mean (SD) age was 52.5 (8.7) years, with HbA1c 7.2% (1.8%), and BMI 28.8 (5.5) kg/m2, and median (interquartile range) HOMA2-IR was 1.6 (1.1–2.2). HF/death occurred in 1,974 (45.4%) participants (235 first HF events, 1,739 deaths) over a median follow-up of 16.4 years. Multivariable independent associations with HF/death were older age and higher BMI, HOMA2-IR, FPG, waist-to-hip ratio, systolic blood pressure, LDL cholesterol, and heart rate as well as sex, race, smoking status, prior atrial fibrillation, and prior microalbuminuria. A doubling of HOMA2-IR was associated with a 5% greater risk of HF/death (relative risk [RR] 1.05 [95% CI 1.01–1.12], P = 0.0029) and a 14% greater risk of HF (RR 1.14, [95% CI 1.02–1.27], P = 0.017). Conclusions: Patients with newly diagnosed T2D and insulin resistance were more likely to develop HF or die than those more sensitive to insulin.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | McMurray, Professor John |
| Authors: | Wamil, M., Coleman, R. L., Adler, A. I., McMurray, J. J.V., and Holman, R. R. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | Diabetes Care |
| Publisher: | American Diabetes Association |
| ISSN: | 0149-5992 |
| ISSN (Online): | 1935-5548 |
| Published Online: | 11 August 2021 |
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