The joint effects of different types of glucose-lowering treatment and duration of diabetes on total and cardiovascular mortality among subjects with type 2 diabetes.

OBJECTIVE: To compare the joint effects of different types of glucose-lowering treatment (oral drugs, insulin, and both) and duration of diabetes on total and cardiovascular mortality among diabetic patients.

METHODS: Study cohorts included 30,534 Ukrainian males and 58,909 females with type 2 diabetes. During the mean follow-up of 2.7 years, 7804 deaths were recorded.

RESULTS: The multivariate-adjusted hazard ratios (HRs) for total mortality among diabetic patients, who used oral glucose-lowering drug (OGLD) only, insulin only, both insulin and OGLD, were 1.00, 2.34, and 2.22 in men, and 1.00, 2.12, and 2.20 in women, respectively. The multivariate-adjusted HRs for total mortality across categories of duration of diabetes (<5, 5-9, 10-14, 15-19, and >/=20 years) were 1.00, 1.17, 1.32, 1.43, and 1.57 (p(trend)<0.001) in men, and 1.00, 1.13, 1.34, 1.74, and 1.68 (p(trend)<0.001) in women, respectively. Diabetic patients who used insulin and reported longer duration of diabetes had the highest risk of total mortality.

CONCLUSION: Type 2 diabetic patients treated with insulin show a greater risk of death than those treated with OGLD only. Increasing duration of diabetes is associated with an increased death risk. The combination of insulin treatment and longer duration of diabetes identifies a particular high death risk.