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N Engl J Med. 2012 Jul 26;367(4):319-28. doi: 10.1056/NEJMoa1203858. Epub 2012 Jun 11.

Basal insulin and cardiovascular and other outcomes in dysglycemia.

Collaborators (2737)

Gerstein H, Yusuf S, Rydén L, Bosch J, Richardson L, Dagenais G, Diaz R, Johnston P, Maggioni A, Probstfield J, Ramachandran A, Riddle M, Vige R, Gerstein H, Yusuf S, Rydén L, Birkeland K, Bosch J, Budaj A, Cardona E, Chazova I, Commerford P, Dagenais G, Diaz R, Danilova L, Davies M, Fernando R, Fodor G, Gilbert R, Gomis R, Hâncu N, Hanefeld M, Hildebrandt P, Johnston P, Kacerovsky-Bielesz G, Keltai M, Kim JH, Krum H, Kültürsay H, Lanas F, Lewis BS, Lonn E, López-Jaramillo P, Maggioni A, Marin-Neto J, Marre M, McKelvie R, McQueen M, Mendoza I, Morillo C, Pan C, Pīrāgs V, Probstfield J, Profozic V, Ramachandran A, Ratner R, Riddle M, Richardson L, Rosenstock J, Spinas GA, Sreenan S, Stoel I, Syvänne M, Vige R, Yale JF, Dagenais G, McKelvie R, Avezum A, Bahit MC, Bogaty P, Bordeleau L, Chacόn C, Corson M, Fodor G, Harper WL, Halon D, Hildebrandt P, Magloire P, Mann J, Morillo C, Pavlova V, Punthakee Z, Silva J, Syvänne M, Tsang B, Yakubovich N, Maggioni A, Probstfield J, Commerford P, Davies M, Gilbert R, Johnston P, Marin-Neto J, McQueen M, Gerstein H, Hanefeld M, Johnston P, Ramachandran A, Ratner R, Riddle M, Rosenstock J, Yale JF, Abdallah A, Ahmad S, Bosch J, Chandra J, Chandra R, Cukierman-Yaffee T, Dyal L, Gerstein H, Jung H, Joldersma L, MacRae L, MacRae S, Malik S, Mead A, Pasha F, Pazmino-Canizares J, Pogue J, Pohl K, Richardson L, Sakalas A, Tyrwhitt J, Yusuf S, Diaz R, Ahuad Guerrero R, Alebuena A, Alvarez N, Alzogaray M, Amuchastegui M, Andres M, Angos M, Baglivo H, Barbieri M, Bassi F, Bello F, Bono J, Bustamante Labarta M, Bustos B, Caccavo A, Calveira M, Camino A, Cantero M, Capozzi M, Cardone M, Cartasegna L, Cassetari A, Castellanos R, Chavez Caballero R, Cipullo M, Contreras A, Coria J, Corinaldesi F, Costa G, Crespo C, Cruz M, Cuello J, Cuneo C, Del Corro I, Diez R, Dituro C, Dominguez A, Facta A, Faingold C, Farah M, Fares Taie A, Fernandez A, Ferrari A, Ferrari N, Garcia Monteverde C, Garrido M, Giachello C, Gonzalez M, Gutierrez N, Guzman L, Guzman P, Hasbani E, Henquin R, Hershon A, Hirschon Alvarez Prado A, Hominal M, Hrabar A, Imposti H, La Grutta M, Lanchiotti P, Lobo Marquez L, Lopez Santi R, Lowenstein J, Lugo M, Luqueci M, Mainini S, Majul C, Manzano R, Manzur S, Marcucci G, Marino M, Massari F, Mendez N, Molina M, Montaña O, Mulazzi M, Nardone L, Odetto I, Orlandini A, Oviedo A, Paez O, Parnas A, Risso Patron F, Pedernera C, Pelagagge M, Plastino M, Polari P, Pomposiello J, Porta A, Prado A, Quiroz M, Ramirez A, Rodriguez C, Rodriguez M, Ronderos R, Sago L, Sanchez A, Sanchez R, Sandrin A, Schygiel P, Sernia V, Sinay I, Smith Casabella T, Sosa Liprandi A, Sosa Liprandi M, Soso L, Sposetti G, Stisman D, Streitenberger P, Suarez G, Tonin H, Ulla M, Valdez J, Vico M, Villamil A, Villarino A, Viscaya Castro A, Visco V, Vogel D, Waisman F, Zaidman C, Krum H, Amerena J, Applebe A, Aylward P, Binnekamp M, Bruce I, Burdeniuk C, Burnet R, Colman P, Colquhoun D, Davis S, De Looze F, De Pasquale C, D'Emden M, Eaton H, Farshid A, Foulanos S, Galanos J, Gordon G, Guhu M, Ho J, Jeffery I, Jerums G, Kwan M, Lefkovits J, Luu S, MacIsaac R, Marjason J, Mohabbati V, Nankervis A, O'Neal D, Perera N, Poynten A, Rahman A, Razak S, Roberts T, Sebastian M, Simpson R, Soldatos G, Sullivan D, Teede H, Tiong F, Topliss D, Torpy D, Waddell-Smith K, Waites J, Wenman J, Whelan A, Williams L, Yeap B, Yeow W, Yong G, Kacerovsky-Bielesz G, Aczel S, Azimy N, Bertha P, Blocher J, Bohnel C, Brath H, Breuss J, De Campo A, Drexel H, Ettmuller Y, Feder A, Feinboeck C, Gulz E, Hofmann M, Hoppichler F, Jahnel H, Jankovic V, Kann T, Kathrein T, Kotter T, Kratz E, Kreuzwieser E, Loreck C, Ludvik B, Marte T, Mellitzer K, Nistler S, Placher-Sorko G, Prager R, Rein P, Riedl M, Säly C, Schernthaner G, Schichka E, Seidlhofer C, Sonnenfeld M, Stefan H, Steiner K, Thomas B, Toplak H, Urstoger K, Vetter B, Vonbank A, Waldschutz W, Wallner F, Winkler F, Danilova L, Goncharik D, Lazareva I, Lichorad N, Mrochek A, Murashko N, Radyuk D, Ramanovski A, Sudzhaeva S, Sujayeva V, Yarashevich N, Campbell G, Marshall S, West A, Marin-Neto J, Abreu F, Alves M, Ayoub-Aidar J, Barros M, Barros-Silveira J, Blacher M, Costa E, Costa F, Daltro C, Delana J, Eliaschewitz F, Facanha C, Feitosa G, Figueiredo J, Forti A, Franco D, Franken M, Freire F, Garcia V, Gouvea-Neto A, Grofallo S, Kanedlai N, Kerr-Saraiva J, Ladeira R, Leaes P, Lemos M, Lima F, Lima Filho M, Macedo L, Manenti E, Marin-Neto J, Monte O, Mossman A, Mothe F, Mouco O, Moyses Golbert M, Nasser Hissa L, Nasser-Hissa M, Nicolau J, Nigro Maia L, Ninno T, Nunes C, Oliveira C, Oliveira O, Passos da silva R, Pericles-Esteves J, Rabelo L, Rabelo-Alves Junior A, Rassi S, Rech R, Roldan F, Salles J, Sampaio C, Seabra A, Sealissi N, Seixas A, Sena R, Shehadeh I, Teixeira M, Turin H, Vicente Serrano C Jr, Vidigal M, Vilela M, Wajchenberg B, Dagenais G, Lonn E, Abbott C, Abu-Bakare A, Ardilouze J, Auersperg E, Bailey A, Bailey G, Baillargeon J, Beaurivage C, Belair J, Belanger A, Bellabarba D, Berlingieri J, Bernier F, Bhargava R, Bhesania T, Booth W, Bose S, Boulianne M, Bourgeois S, Breton D, Brossoit R, Buithieu J, Campeau J, Carlson B, Carpentier A, Cavalcanti R, Cha J, Chagnon P, Chan Y, Chessex C, Chiasson J, Chouinard S, Clayton D, Conway J, Crepeau J, Cudmore D, D'Ignazio G, Doig G, Dominguez M, Dube F, Dumas R, Dupuis R, Dyrda I, Eddy D, Eiley D, Fox H, Fratesi S, Gallant S, Garceau C, Garfield N, Germain C, Glazer S, Gosselin G, Gould D, Grills G, Halle J, Hardin P, Harper W, Heath J, Heath V, Hivert M, Ho K, Houde G, Hramiak I, Hutchinson A, Huynh T, Ilie-Haynes R, Imran S, Islam A, Iwanochko M, Jones C, Joyce C, Kirouac I, Kumar R, Lamothe M, Langlois M, Lauzon C, Lavoie M, Leader R, Lecours S, Lepage S, Lochnan H, Ma P, Malik S, McLean A, Mecci S, Mehta P, Mercier M, Miller D, Morisset A, Nawaz S, Nisker W, Nyomba G, O'Keefe D, Palardy J, Parekh P, Paul T, Perron P, Pesant M, Phillips R, Pruneau G, Quintin I, Raby K, Richard C, Rosenfeld G, Saulnier D, Shaban J, Shah A, Shu D, Sigal R, Silverman M, Singh J, Sivucha W, Skamene A, Sliwowicz D, Smith R, St Hilaire R, Steinson D, Sussex B, Tan K, Tannous R, Telner A, Theroux P, Tsoukas C, Tsoukas G, van Buuren J, VanRossum N, Vexler R, Vizel S, Warnica W, Weingert M, Wilson R, Wilson R, Wong W, Woo V, Yale J, Lanas F, Acevedo M, Alwyn C, Baier E, Baier S, Galloso R, Lahsen R, Lorenas G, Montecinos A, Montecinos M, Pineda P, Pollak F, Sapunar J, Serrano V, Stockins B, Varleta P, Yovanovich J, Zambra F, Pan C, Ba J, Bao Y, Bi Y, Bu S, Chen B, Chen H, Chen H, Chen J, Chen L, Chen L, Chen M, Chen Y, Chen Y, Cui J, Dong M, Feng P, Feng Z, Gao C, Gao F, Gao X, Gao Z, Gong Y, Guang L, Guo X, Han F, Han X, Hou X, Hu R, Ji L, Jia J, Jia W, Jiao X, Jin X, Kuang J, Li M, Li Q, Li X, Li Y, Ling Y, Liu F, Liu Z, Lu B, Lu J, Lu Z, Lv X, Ning G, Peng Y, Ren Y, Shao Y, Shi Y, Shu X, Sun H, Sun L, Sun X, Tang K, Tian H, Tian H, Wang C, Wang F, Wang L, Wang Q, Wang W, Wang X, Wang Y, Wang Y, Wen J, Wu C, Wu H, Wu H, Wu J, Wu M, Xing X, Xue Y, Yan L, Yan S, Yang H, Yang N, Yang W, Yang Z, Yao J, Yao J, Yao L, Yu D, Yu H, Yu M, Yu X, Yuan L, Yuan M, Yuan S, Yuan W, Yuan Y, Yuan Z, Zeng T, Zhang J, Zhang R, Zhang X, Zhang X, Zhao L, Zheng B, Zheng J, Zheng J, Zhou W, Zhu N, Zhu Y, Zou D, Zou J, Lopez-Jaramillo P, Morillo C, Accini JL, Bohorquez R, Botero R, Cure C, Figueredo M, Hernandez E, Kattah W, Llamas A, Orozco L, Pava L, Perez M, Pineda M, Quintero A, Quiros R, Urina M, Velez S, Profozic V, Altabas V, Baotic I, Berkovic M, Goldoni V, Kerum T, Mirosevic G, Tarle D, Vidovic I, Zjacic-Rotkvic V, Hildebrandt P, Abbas R, Andersen H, Auscher S, Baumbach L, Brockstedt H, Christensen P, Christiansen M, Clemmensen K, Egstrup K, Gislason G, Haar D, Hansen K, Heden Andersen P, Helleberg K, Hermansen K, Holmer J, Jeppesen J, Klausen I, Koustrup-Sonder T, Krarup T, Lerche S, Lervang H, Linde B, Lund P, Lund S, Madsbed S, Molvig J, Orskov C, Ostergaaard O, Perrild H, Pietraszek A, Ralfkjaer N, Roenne H, Rokkedal Nielsen J, Seibaek M, Soendergaard H, Sorensen L, Sundahl Mortensen L, Torp-Pedersen C, Tuxen C, Urhammer S, Vadstrup E, Pirags V, Ambos A, Janson A, Rudenko P, Viitas L, Syvänne M, Aranko S, Badeau M, Eriksson J, Haapamäki H, Kajander O, Kuusisto A, Luukkonen S, Mäkelä J, Nieminen S, Niskanen L, Ripatti J, Ruotsalainen S, Saltevo J, Sävelä K, Strand J, Valle T, Virkamäki A, Marre M, Aboud E, Alavoine L, Bekherraz A, Bohme P, Bourezane H, Catargi B, Charpentier G, Clergeot A, Courreges J, Delmas T, Duengler F, Feknous C, Gendre D, Guerci B, Hadjadj S, Kerlan V, Laguerre N, Le Potier J, Lombardo F, Malville E, Marechaud R, Mattei C, Moreira J, Penfornis A, Petit C, Pinel J, Piquel X, Raccah D, Reznik Y, Rod A, Roudaut N, Rousseau E, Schillo F, Schmitt B, Sonnet E, Torremocha F, Travert F, Vanhoute C, Vimeux M, Hanefeld M, Abdollahnia R, Adamidou A, Arslan S, Bach-Kliegel B, Bartusch B, Bauer N, Bieler T, Blankenfeld H, Boeckmann U, Busch K, Butzer R, Chenchanna-Merzhaeuser M, Denger R, Deutsch C, Diessel S, Donati-Hirsch I, Dornisch M, Enghofer K, Fleig T, Forst T, Frommherz M, Goeller K, Habbig J, Hadziselimovic S, Hamann A, Hampel T, Heger S, Helmes C, Hoffman C, Hohberg C, Humpert P, Kamke A, Kamke W, Kindermann P, Klein C, Klein D, Koehler A, Kuehn A, Langer K, Limmer S, Loew A, Maimer A, Marck C, Meier G, Methner-Friederich M, Metzler W, Meyer K, Miftari N, Milde J, Minnich J, Molkewehrum M, Morcos M, Mueller-Hoff C, Nguyen M, Nishwitz M, Oldenburg J, Ott P, Pauli K, Pauly B, Pfeiffer A, Pfuetzner A, Pischa U, Radke R, Reismann P, Riemer M, Rochlitz H, Rudofsky G, Ruhla S, Sammler A, Schaper F, Schiemenz K, Scholz G, Schumm-Draeger P, Segiet T, Segner A, Seissler J, Spahn S, Stier U, Tonon G, von Amelunxen S, von Schacky C, Wilhelm B, Wilhelm K, Witt K, Wuechner-Hofmann S, Keltai M, Baranyai M, Birkus Z, Foldesi I, Gaal Z, Harcsa E, Hati K, Hohmann Z, Istenes I, Jozsef I, Juhasz E, Kempler P, Keresztes B, Keresztes K, Kis-Gombos P, Kovacs I, Kozma T, Laszlo Z, Noori E, Nyirati G, Papp Z, Patkay J, Poor F, Pusztai P, Putz Z, Rigo E, Sereg M, Simon K, Somogyi A, Sumegi J, Szabo A, Szabo J, Szigeti S, Szilveszter D, Tarko M, Varga C, Varga Szabo L, Voros P, Ramachandran A, Arathi, Aravind S, Badgandi M, Balaji M, Balaji V, Chamukuttan S, Devi Manduva P, Fatima S, Ganapathy B, George O, George P, Jaffar M, Jain P, Kamath P, Karthik V, Koshy G, Krishnan L, Kumar H, Lal P, Mithal A, Modi S, Mohan V, Moses V, Oomen R, Pais P, Pati P, Pendsey S, Rai P, Rajagopal R, Ramu M, Ranjit U, Rao P, Senthil V, Seshaiah V, Sethi B, Shah P, Sharma R, Shetty S, Shobha A, Siddharth R, Sridhar G, Sudeep K, Sunil C, Sunitha S, Suresh S, Thomas N, Vageesh A, Sreenan S, Anwer Z, Barton J, Behan L, Bell M, Cullen M, Dineen S, Draman Yusof M, Dunne F, Gibney J, Hussain T, Khan M, Kinsley B, Kyithar P, Lavin F, McGowan A, McGurk C, Mirza A, Mohammadi B, O'Brien T, O'Connell J, O'Halloran D, O'Shea D, Roberts G, Tomkin G, Wan Mahmood W, Lewis BS, Abramod-Ness R, Adawi F, Aharon B, Backer M, Beniashvili A, Berliner A, Bloch L, Bugelman D, Butnaru A, Cohen O, Cohen Y, Frenkel M, Glant M, Gustava B, Guttman H, Halabi S, Halon D, Harman-Boehm I, Ilany J, Karkabi B, Khader N, Khaskia A, Khudyak Y, Klainman E, Kogan N, Lender D, Levin I, Mardi T, Marmor A, Mosseri M, Nabriski D, Omary M, Orlovsky S, Peres D, Quasim M, Raz I, Remesnik M, Rogowski O, Rozenfeld I, Scharr D, Shnifer I, Shuster T, Solomon R, Steiner H, Tzivoni D, Wolfson N, Yossef Z, Zahger D, Zeltser D, Zimlichman R, Maggioni A, Aina F, Ariatti C, Bonetti R, Cacciatore F, Calcinaro F, Corona G, De Maria P, Del Prato S, Derosa G, Di Pasquale G, Falorni A, Fanelli R, Fedele D, Filorizzo G, Fogari R, Furgi G, Ghio A, Giorda C, Gregori G, Iannuzzi G, Lapolla A, Luciano B, Lucotti P, Maggi A, Marafetti L, Marchese T, Martino G, Marzotti S, Miccoli R, Monti LD, Moretti L, Palvarini M, Petacchi R, Piarulli F, Piatti PM, Rudi S, Santeusanio F, Sesti G, Setola E, Sforza A, Shehaj E, Veniani M, Viviani G, Zigoura E, Kim JH, Chae S, Cho D, Cho E, Cho Y, Choi Y, Chung M, Hong E, Hong Y, Jeong M, Kim B, Kim D, Kim H, Kim I, Kim J, Kim J, Kim P, Kim S, Kim S, Koo B, Kwok S, Kwon H, Lee J, Lee J, Lim J, Oh S, Ohn J, Park C, Park H, Park K, Seung K, Son H, Woo J, Yoon K, Pirags V, Ansmite B, Balcere I, Bumbure A, Ducena K, Lejnieks A, Rasa I, Ritenberga R, Romanova M, Salmina I, Steina S, Pirags V, Badariene J, Gailiuniene S, Grigonis S, Juskiene R, Petrulioniene Z, Sakalyte G, Stasiunas T, Sulskiene M, Urbonaite B, Zarankiene R, Ziukaite R, Cardona E, Arechavaleta R, Beltran-Jaramillo T, Calvo-Vargas C, Campillo-Cardenas C, Cardona D, Carmona-Huerta J, Cedano-Limon M, Comellas-De Armas M, Dominguez C, Gomez-Cruz J, Gonzalez-Perez R, Illescas J, Jimenez-Ramos S, Lopez-Alvarado A, Marquez-Rodriguez E, Martinez G, Pascoe S, Plascencia Vazquez O, Rodriguez H, Ruiz-Cornejo M, Velasco-Sanchez G, Vidrio-Velazquez M, Villeda-Espinosa E, Stoel I, Badings E, Bartels G, Bruggink-Andre de la Porte P, Bruijns E, Cornel J, De Milliano P, De Mulder M, De Swart J, Derks A, Dirkali A, Droste J, Galjee M, Hautvast R, Hermans W, Holwerda N, Ilmer B, Kofflard M, Kooistra-Huizer J, Kurvers M, Langerveld J, Leenders C, Liem A, Lok D, Neumann D, Nierop P, Plomp K, Posma J, Reichert C, Roeters Van Lennep H, Ronner E, Said S, Takens L, Umans V, Van der Sluis AA, Van der Zwaan C, Van Dobbenburgh J, Van Es A, Van Hessen M, Van Mechelen R, Van Miltenburg-Van Zijl A, Van Zeijl L, Veerhoek M, Viergever E, Weijers EE, Willems F, Birkeland K, Blix I, Cooper J, Debowska A, Erichsen K, Fossum J, Gjertsen E, Grill V, Gudnason S, Hoye K, Istad H, Winther J, Joakimsen R, Jorde R, Larsen I, Mella B, Otterstad J, Risberg K, Skare K, Skeie S, Sommervoll L, Tandberg A, Whitfield R, Wium C, Fernando R, Cunanan E, Fernando-Catindig E, Gomez M, Jaring C, Lantion-Ang F, Licaros M, Lim J, Lim-Abrahan M, Madronio E, Panelo A, Raboca J, Ramos G, Tugna S, Budaj A, Aksamit-Bialoszewska E, 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Abstract

BACKGROUND:

The provision of sufficient basal insulin to normalize fasting plasma glucose levels may reduce cardiovascular events, but such a possibility has not been formally tested.

METHODS:

We randomly assigned 12,537 people (mean age, 63.5 years) with cardiovascular risk factors plus impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes to receive insulin glargine (with a target fasting blood glucose level of ≤95 mg per deciliter [5.3 mmol per liter]) or standard care and to receive n-3 fatty acids or placebo with the use of a 2-by-2 factorial design. The results of the comparison between insulin glargine and standard care are reported here. The coprimary outcomes were nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes and these events plus revascularization or hospitalization for heart failure. Microvascular outcomes, incident diabetes, hypoglycemia, weight, and cancers were also compared between groups.

RESULTS:

The median follow-up was 6.2 years (interquartile range, 5.8 to 6.7). Rates of incident cardiovascular outcomes were similar in the insulin-glargine and standard-care groups: 2.94 and 2.85 per 100 person-years, respectively, for the first coprimary outcome (hazard ratio, 1.02; 95% confidence interval [CI], 0.94 to 1.11; P=0.63) and 5.52 and 5.28 per 100 person-years, respectively, for the second coprimary outcome (hazard ratio, 1.04; 95% CI, 0.97 to 1.11; P=0.27). New diabetes was diagnosed approximately 3 months after therapy was stopped among 30% versus 35% of 1456 participants without baseline diabetes (odds ratio, 0.80; 95% CI, 0.64 to 1.00; P=0.05). Rates of severe hypoglycemia were 1.00 versus 0.31 per 100 person-years. Median weight increased by 1.6 kg in the insulin-glargine group and fell by 0.5 kg in the standard-care group. There was no significant difference in cancers (hazard ratio, 1.00; 95% CI, 0.88 to 1.13; P=0.97).

CONCLUSIONS:

When used to target normal fasting plasma glucose levels for more than 6 years, insulin glargine had a neutral effect on cardiovascular outcomes and cancers. Although it reduced new-onset diabetes, insulin glargine also increased hypoglycemia and modestly increased weight. (Funded by Sanofi; ORIGIN ClinicalTrials.gov number, NCT00069784.).

Comment in

PMID:
22686416
[PubMed - indexed for MEDLINE]
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