No extra benefit from long-acting insulin
Using long-acting insulin for more than six years has no effect on cardiovascular outcomes and cancers, according to a study published online in the New England Journal of Medicine (11 June 2012).
The "outcome reduction with an initial glargine intervention" (ORIGIN) trial included 12,537 patients with cardiovascular risk factors and impaired fasting glucose, impaired glucose tolerance or early type 2 diabetes. Patients were assigned to receive insulin glargine (targeting a self-measured fasting plasma glucose level of 5.3mmol per litre or less) or standard care, which differed depending on diabetes status.
The first co-primary outcome was death from cardiovascular disease, non-fatal myocardial infarction or non-fatal stroke, and the second was a composite of these events plus revascularisation or admission to hospital for heart failure.
After one year, half of patients in the insulin glargine group had reached the fasting plasma glucose target level, which was maintained over six years.
The incidence of both co-primary outcomes did not differ significantly between treatment groups, with a hazard ratio of 1.02 for co-primary outcome 1 (95 per cent confidence interval 0.94–1.11, P=0.63) and 1.04, for co-primary outcome 2 (CI 0.97–1.11, P=0.27).
Effect of omega-3
Patients in each of the treatment groups (insulin glargine or standard care) were also assigned to receive either 1g omega-3 fatty acids or placebo daily.
Supplementation with omega-3 fatty acids did not reduce cardiovascular disease deaths, which occurred in 9.1% of patients compared with 9.3% of patients receiving placebo (hazard ratio 0.98, 95% confidence interval 0.87–1.10, P=0.72).
Citation: The Pharmaceutical Journal URI: 11103235