Risk of early mortality and cardiovascular disease according to the presence of recently diagnosed diabetes and requirement for insulin treatment: A nationwide study

• Published in: Journal of diabetes investigation Vol. 12; no. 10; pp. 1855 - 1863
• Main Authors: Lee, You‐Bin, Han, Kyungdo, Kim, Bongsung, Choi, Min Sun, Park, Jiyun, Kim, Minyoung, Jin, Sang‐Man, Hur, Kyu Yeon, Kim, Gyuri, Kim, Jae Hyeon
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01-10-2021; John Wiley and Sons Inc; Wiley
• Subjects: Adult; Age; Aged; Cardiovascular disease; Cardiovascular diseases; Cerebral infarction; Codes; Death; Dementia; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - mortality; Family income; Female; Health services utilization; Hospitalization; Humans; Hypertension; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - therapeutic use; Insulin resistance; Longitudinal Studies; Low income groups; Male; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - epidemiology; Original; Population studies; Prescriptions; Republic of Korea - epidemiology; Risk Assessment; Stroke; Stroke - epidemiology; Type 2 diabetes mellitus; Republic of Korea; Insulin; Mortality; Type 2 diabetes mellitus
• ISSN: 2040-1116; 2040-1124
• DOI: 10.1111/jdi.13539

Aims/Introduction
We estimated the hazards of cardiovascular diseases (CVDs) and early all‐cause mortality in Korean adults according to the presence of recently diagnosed type 2 diabetes (type 2 diabetes for <5 years) and insulin use.
Materials and Methods
We used the Korean National Health Insurance Service–National Sample Cohort database (2002–2015) for this longitudinal population‐based study. Among adults aged ≥40 years without baseline CVD, individuals without diabetes or with recently diagnosed type 2 diabetes were selected (N = 363,919). The hazard ratios (HRs) for myocardial infarction (MI), stroke, and all‐cause mortality during follow‐up were analyzed according to three groups categorized by the presence of type 2 diabetes and insulin use.
Results
Within a mean 7.8 years, there were 5,275 MIs, 7,220 strokes, and 15,834 deaths. The hazards for outcomes were higher in the insulin‐treated type 2 diabetes group than in the non‐diabetes group [HR (95% CI): 2.344 (1.870–2.938) for MI, 2.420 (1.993–2.937) for stroke, and 3.037 (2.706–3.407) for death], higher in the non‐insulin‐treated type 2 diabetes group than in the non‐diabetes group [HR (95% CI): 1.284 (1.159–1.423) for MI, 1.435 (1.320–1.561) for stroke, and 1.135 (1.067–1.206) for death], and higher in the insulin‐treated type 2 diabetes group than in the non‐insulin‐treated type 2 diabetes group [HR (95% CI): 1.914 (1.502–2.441) for MI, 1.676 (1.363–2.060) for stroke, and 2.535 (2.232–2.880) for death].
Conclusions
Recently diagnosed type 2 diabetes patients showed increased risks of incident CVDs and premature mortality, and insulin‐treated group demonstrated an additional increase in the risks of these outcomes in adults with recently diagnosed type 2 diabetes, suggesting the need for intensified cardio‐protective interventions for adults with insulin‐treated type 2 diabetes.
In this nationwide, longitudinal, population‐based cohort study including 363,919 individuals either with no diabetes or with recently diagnosed type 2 diabetes, we compared the hazard for myocardial infarction, stroke, and early mortality according to the presence of type 2 diabetes and insulin use in the real‐world utilizing the Korean National Health Insurance Service–National Sample Cohort (NHIS‐NSC) database. Recently diagnosed type 2 diabetes patients showed increased risks of incident myocardial infarction, stroke, and all‐cause mortality during follow‐up, and insulin‐treated group demonstrated an additional increase in the risks of these outcomes in adults with recently diagnosed type 2 diabetes.