Due to necessary scheduled maintenance, the JMIR Publications website will be unavailable from Wednesday, July 01, 2020 at 8:00 PM to 10:00 PM EST. We apologize in advance for any inconvenience this may cause you.
Who will be affected?
Readers: No access to all 28 journals. We recommend accessing our articles via PubMed Central
Authors: No access to the submission form or your user account.
Reviewers: No access to your user account. Please download manuscripts you are reviewing for offline reading before Wednesday, July 01, 2020 at 7:00 PM.
Editors: No access to your user account to assign reviewers or make decisions.
Copyeditors: No access to user account. Please download manuscripts you are copyediting before Wednesday, July 01, 2020 at 7:00 PM.
Wang X, Plantinga AM, Xiong X, Cromer SJ, Bonzel CL, Panickan V, Duan R, Hou J, Cai T
Comparing Insulin Against Glucagon-Like Peptide-1 Receptor Agonists, Dipeptidyl Peptidase-4 Inhibitors, and Sodium-Glucose Cotransporter 2 Inhibitors on 5-Year Incident Heart Failure Risk for Patients With Type 2 Diabetes Mellitus: Real-World Evidence Study Using Insurance Claims
Comparing insulin vs GLP-1 RA, DPP4I, SGLT2I on 5-year incident heart failure for patients with type 2 diabetes mellitus: a real-world evidence study using insurance claims
Xuan Wang;
Anna M. Plantinga;
Xin Xiong;
Sara J. Cromer;
Clara-Lea Bonzel;
Vidul Panickan;
Rui Duan;
Jue Hou;
Tianxi Cai
ABSTRACT
Background:
Type 2 diabetes mellitus (T2D) is a common health issue, with heart failure (HF) being the common and lethal long-term complication. Although insulin is widely used for the treatment of T2D, evidence regarding the efficacy of insulin compared to non-insulin therapies on incident heart failure risk is missing among randomized clinical trials. Real-world evidence on insulin’s effect on long-term heart failure may supplement existing guidelines on the management of T2D.
Objective:
This study compared the insulin therapy versus other medications on heart failure (HF) among T2D patients using real-world data (RWD) extracted from insurance claims.
Methods:
We employed doubly robust Augmented Inverse Probability Weighted estimation that extensively adjusted for high-dimensional confounding factors in both the propensity score and outcome regression models, using a data-driven approach for feature selection implemented through a LASSO sparsity penalty in each model.
Results:
After adjusting for broad list of confounders, insulin was found to be associated with 11.8% [95% CI: 11.0%-12.7%] higher 5-year HF rate compared to patients receiving GLP-1, 12.0% [95% CI: 11.5%-12.4%] higher 5-year HF rate compared to DPP-4, and 15.1% [95% CI: 14.3%-16.0%] higher 5-year HF rate compared to SGLT-2. Subgroup analysis shows the insulin effect with a higher HF rate is significant in subgroup with high baseline HF risk but not significant in subgroup with low baseline HF risk.
Conclusions:
This study generated real-world evidence on the association with higher 5-year heart failure rate of insulin therapy compared to GLP-1, DPP-4, and SGLT-2 based on claims data. These findings also demonstrated the value of real-world data for comparative effectiveness studies to complement established guidelines. On the other hand, the study shares the common limitation of observational studies. Even though high-dimensional confounders are adjusted, remaining confounding may exist and induce bias in analysis.
Citation
Please cite as:
Wang X, Plantinga AM, Xiong X, Cromer SJ, Bonzel CL, Panickan V, Duan R, Hou J, Cai T
Comparing Insulin Against Glucagon-Like Peptide-1 Receptor Agonists, Dipeptidyl Peptidase-4 Inhibitors, and Sodium-Glucose Cotransporter 2 Inhibitors on 5-Year Incident Heart Failure Risk for Patients With Type 2 Diabetes Mellitus: Real-World Evidence Study Using Insurance Claims