Analog vs Human Insulin Tied to Lower Death Risk in the Hemodialysis Population

Treatment with analog rather than human insulin may result in better clinical outcomes in patients with type 2 diabetes receiving maintenance hemodialysis (HD), investigators suggest.

In the multinational Analyzing Data, Recognizing Excellence and Optimizing Outcomes (ARO) ii study, investigators compared outcomes between 713 analog insulin and 733 human insulin users. In adjusted multivariable analyses, significantly lower proportions of the analog than human insulin group experienced major adverse cardiovascular events (MACE, 26.8% vs 35.9%), hospitalization (58.2% vs 75.0%), and all-cause mortality (22.0% vs 31.4%), James Fotheringham, PhD, of the University of Sheffield in Sheffield, UK, and colleagues reported in the American Journal of Kidney Diseases. Analog users had significant 18.3%, 24.3%, 19.2% lower risks for these outcomes, respectively. MACE was defined as hospitalization for coronary, cerebral, or peripheral arterial events, heart failure, or cardiac arrest.

Hypoglycemia (less than 3.0 mmol/L) occurred at comparable rates among analog and human insulin users: 14.1% vs 15.0%.

Insulin therapy is the “cornerstone” of antihyperglycemic treatment in kidney failure since these patients are ineligible for sodium-glucose contransporter 2 inhibitors, Dr Fotheringham’s team noted.

“Both long- and short-acting analogues, therefore, could significantly reduce glycemic variability, which has been linked to mortality in people on HD, without necessarily modifying HbA1c.”

Human insulin, they noted, has been linked with postprandial hyperglycemia followed by hypoglycemia and weight gain.

Since this was an observational study, residual confounding could not be ruled out, such as the cost and availability of each insulin type.

Disclosure: This research was supported by Amgen. Please see the original reference for a full list of disclosures.

This article originally appeared on Renal and Urology News