Long-acting insulin analogues and the risk of diabetic nephropathy among patients with type 2 diabetes: A population-based cohort study

Abstract

Aims: The risk of diabetic nephropathy among patients with type 2 diabetes (T2D) can be reduced through optimal glycaemic control. It is not known if the pharmacological properties of long-acting insulin analogues may reduce the risk of diabetic complications compared with neutral protamine Hagedorn (NPH) insulin. We compared the risk of diabetic nephropathy associated with the use of long-acting insulin analogues with the use of intermediate-acting NPH insulin among patients with T2D. Materials and Methods: We conducted a retrospective cohort study using an active-comparator, new user design and the United Kingdom's Clinical Practice Research Datalink AURUM. Our primary outcome was incident diabetic nephropathy, and our secondary outcomes were chronic kidney disease (CKD) and end-stage renal disease (ESRD). We used Cox proportional hazards models with inverse probability of treatment weighting to estimate hazard ratios (HR) and 95% confidence intervals (CI) for each outcome associated with long-acting insulin analogues versus NPH insulin. Results: The incidence rate (per 1000 person-years) of diabetic nephropathy was 16.3 (95% CI: 15.3–17.4) among initiators of long-acting insulin analogues and 17.5 (95% CI: 16.3–18.8) among initiators of NPH insulin. Compared with NPH insulin, long-acting insulin analogues were not associated with the risk of diabetic nephropathy (adjusted HR: 0.94, 95% CI: 0.85–1.04). The adjusted HR was 0.91 (95% CI: 0.88–0.94) for CKD and 0.78 (95% CI: 0.46–1.32) for ESRD. Conclusions: We did not find an association between use of a long-acting insulin analogue, compared with use of NPH insulin, and the risk of diabetic nephropathy among patients with T2D.