Clinical Question

Is there a difference in the long-term morbidity and mortality in adults with type 2 diabetes mellitus who are treated with human insulin vs. analogue insulin?

Bottom Line

This study found no difference in long-term patient-oriented outcomes between human and analogue insulins in adults with type 2 diabetes. Recent evidence also found no difference in the rates of severe hypoglycemia. The best evidence shows no proven benefit to using analogue insulins instead of the older human insulins, and potential harm because the higher cost of analogue insulins may prohibit patient acquisition. (Level of Evidence = 2b)

Synopsis

The investigators analyzed data from four large integrated health care delivery systems in the United States, specifically identifying adults who filled a first insulin prescription from January 1, 2005, through December 31, 2013. Continuous treatment with the same insulin therapy was determined based on prescription refill dates. A total of 127,600 participants met eligibility criteria, including having type 2 diabetes and an initial date of insulin therapy. The individuals who assessed outcomes obtained vital statistics from hospital records, state registries, and national registries. Adjustments occurred in outcomes to control for potential confounders, including patient demographics, comorbid conditions, medication use, smoking, and socioeconomic variables. Adjusted hazard ratios for continuous exposure to analogue vs. human insulin demonstrated no significant differences in all-cause mortality, mortality due to cardiovascular disease, myocardial infarction, and congestive heart failure hospitalization.

Study design: Cohort (retrospective)

Funding source: Government

Setting: Population-based

Reference: Neugebauer R, Schroeder EB, Reynolds K, et al. Comparison of mortality and major cardiovascular events among adults with type 2 diabetes using human vs analogue insulins. JAMA Netw Open. 2020;3(1):e1918554.