Insulin provision therapy and mortality in older adults with diabetes mellitus and stable ischemic heart disease: Insights from BARI-2D trial

Abdulla A. Damluji, Erin R. Cohen, Mauro Moscucci, Robert J Myerburg, Mauricio G Cohen, Maria M. Brooks, Michael W. Rich, Daniel E. Forman

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Importance Optimal strategies for glucose control in very old adults with diabetes and stable ischemic heart disease (SIHD) are unclear. Objective To compare the effects of insulin provision (IP) therapy versus insulin sensitizing (IS) therapy for glycemic control in older (≥ 75 years) and younger (< 75 years) adults with type II diabetes (DM) and SIHD. Design, setting, and participants Adults enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) were studied. The BARI 2D study population (all with type II DM and SIHD) was randomized twice: (1) between revascularization plus intensive medical therapy versus intensive medical therapy alone, and (2) between IP versus IS therapies. The primary endpoint was all-cause-mortality over five-year follow-up. In this substudy outcomes related to IP vs. IS are assessed in relation to age. Adults aged ≥ 75 years who received IP versus IS are compared to those < 75 years who received IP versus IS. Multivariate Cox regression analysis was used to evaluate the effects of IP vs. IS on outcomes in the two age groups. Results 2368 subjects with SIHD and DM were enrolled in BARI 2D; 182 (8%) were ≥ 75 years. Compared to younger subjects, the older cohort had lower BMI, higher diuretic use, worse kidney function, and increased history of heart failure. Within the older cohort, the IP and IS subgroups were similar in respect to baseline cardiovascular risk factors, medications, and coronary artery disease severity. During follow-up, the older subjects receiving IP therapy had higher cardiovascular mortality compared to those receiving IS therapy (16% vs. 11%, p = 0.040). Using Cox proportional hazards analysis, the older IP subjects were at increased risk for all-cause-mortality (hazard ratio 1.89, CI 1.1–3.2, p = 0.020). No mortality difference between IP and IS was observed in those < 75 years of age. Conclusion and relevance Among adults with diabetes and SIHD aged ≥ 75 years, IP therapy may be associated with increased mortality compared to IS therapy. Additional studies are needed to further refine optimal treatment strategies for diabetes and SIHD in old age.

Original languageEnglish (US)
Pages (from-to)35-40
Number of pages6
JournalInternational Journal of Cardiology
Volume241
DOIs
StatePublished - Aug 15 2017

Fingerprint

Type 2 Diabetes Mellitus
Myocardial Ischemia
Insulin
Mortality
Therapeutics
Angioplasty
Diuretics

Keywords

  • BARI 2D
  • Diabetes mellitus
  • Elderly
  • Insulin
  • Ischemic heart disease

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Insulin provision therapy and mortality in older adults with diabetes mellitus and stable ischemic heart disease : Insights from BARI-2D trial. / Damluji, Abdulla A.; Cohen, Erin R.; Moscucci, Mauro; Myerburg, Robert J; Cohen, Mauricio G; Brooks, Maria M.; Rich, Michael W.; Forman, Daniel E.

In: International Journal of Cardiology, Vol. 241, 15.08.2017, p. 35-40.

Research output: Contribution to journalArticle

Damluji, Abdulla A. ; Cohen, Erin R. ; Moscucci, Mauro ; Myerburg, Robert J ; Cohen, Mauricio G ; Brooks, Maria M. ; Rich, Michael W. ; Forman, Daniel E. / Insulin provision therapy and mortality in older adults with diabetes mellitus and stable ischemic heart disease : Insights from BARI-2D trial. In: International Journal of Cardiology. 2017 ; Vol. 241. pp. 35-40.
@article{84c6f62f5e1a449fa965926f15cb56d0,
title = "Insulin provision therapy and mortality in older adults with diabetes mellitus and stable ischemic heart disease: Insights from BARI-2D trial",
abstract = "Importance Optimal strategies for glucose control in very old adults with diabetes and stable ischemic heart disease (SIHD) are unclear. Objective To compare the effects of insulin provision (IP) therapy versus insulin sensitizing (IS) therapy for glycemic control in older (≥ 75 years) and younger (< 75 years) adults with type II diabetes (DM) and SIHD. Design, setting, and participants Adults enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) were studied. The BARI 2D study population (all with type II DM and SIHD) was randomized twice: (1) between revascularization plus intensive medical therapy versus intensive medical therapy alone, and (2) between IP versus IS therapies. The primary endpoint was all-cause-mortality over five-year follow-up. In this substudy outcomes related to IP vs. IS are assessed in relation to age. Adults aged ≥ 75 years who received IP versus IS are compared to those < 75 years who received IP versus IS. Multivariate Cox regression analysis was used to evaluate the effects of IP vs. IS on outcomes in the two age groups. Results 2368 subjects with SIHD and DM were enrolled in BARI 2D; 182 (8{\%}) were ≥ 75 years. Compared to younger subjects, the older cohort had lower BMI, higher diuretic use, worse kidney function, and increased history of heart failure. Within the older cohort, the IP and IS subgroups were similar in respect to baseline cardiovascular risk factors, medications, and coronary artery disease severity. During follow-up, the older subjects receiving IP therapy had higher cardiovascular mortality compared to those receiving IS therapy (16{\%} vs. 11{\%}, p = 0.040). Using Cox proportional hazards analysis, the older IP subjects were at increased risk for all-cause-mortality (hazard ratio 1.89, CI 1.1–3.2, p = 0.020). No mortality difference between IP and IS was observed in those < 75 years of age. Conclusion and relevance Among adults with diabetes and SIHD aged ≥ 75 years, IP therapy may be associated with increased mortality compared to IS therapy. Additional studies are needed to further refine optimal treatment strategies for diabetes and SIHD in old age.",
keywords = "BARI 2D, Diabetes mellitus, Elderly, Insulin, Ischemic heart disease",
author = "Damluji, {Abdulla A.} and Cohen, {Erin R.} and Mauro Moscucci and Myerburg, {Robert J} and Cohen, {Mauricio G} and Brooks, {Maria M.} and Rich, {Michael W.} and Forman, {Daniel E.}",
year = "2017",
month = "8",
day = "15",
doi = "10.1016/j.ijcard.2017.03.048",
language = "English (US)",
volume = "241",
pages = "35--40",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Insulin provision therapy and mortality in older adults with diabetes mellitus and stable ischemic heart disease

T2 - Insights from BARI-2D trial

AU - Damluji, Abdulla A.

AU - Cohen, Erin R.

AU - Moscucci, Mauro

AU - Myerburg, Robert J

AU - Cohen, Mauricio G

AU - Brooks, Maria M.

AU - Rich, Michael W.

AU - Forman, Daniel E.

PY - 2017/8/15

Y1 - 2017/8/15

N2 - Importance Optimal strategies for glucose control in very old adults with diabetes and stable ischemic heart disease (SIHD) are unclear. Objective To compare the effects of insulin provision (IP) therapy versus insulin sensitizing (IS) therapy for glycemic control in older (≥ 75 years) and younger (< 75 years) adults with type II diabetes (DM) and SIHD. Design, setting, and participants Adults enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) were studied. The BARI 2D study population (all with type II DM and SIHD) was randomized twice: (1) between revascularization plus intensive medical therapy versus intensive medical therapy alone, and (2) between IP versus IS therapies. The primary endpoint was all-cause-mortality over five-year follow-up. In this substudy outcomes related to IP vs. IS are assessed in relation to age. Adults aged ≥ 75 years who received IP versus IS are compared to those < 75 years who received IP versus IS. Multivariate Cox regression analysis was used to evaluate the effects of IP vs. IS on outcomes in the two age groups. Results 2368 subjects with SIHD and DM were enrolled in BARI 2D; 182 (8%) were ≥ 75 years. Compared to younger subjects, the older cohort had lower BMI, higher diuretic use, worse kidney function, and increased history of heart failure. Within the older cohort, the IP and IS subgroups were similar in respect to baseline cardiovascular risk factors, medications, and coronary artery disease severity. During follow-up, the older subjects receiving IP therapy had higher cardiovascular mortality compared to those receiving IS therapy (16% vs. 11%, p = 0.040). Using Cox proportional hazards analysis, the older IP subjects were at increased risk for all-cause-mortality (hazard ratio 1.89, CI 1.1–3.2, p = 0.020). No mortality difference between IP and IS was observed in those < 75 years of age. Conclusion and relevance Among adults with diabetes and SIHD aged ≥ 75 years, IP therapy may be associated with increased mortality compared to IS therapy. Additional studies are needed to further refine optimal treatment strategies for diabetes and SIHD in old age.

AB - Importance Optimal strategies for glucose control in very old adults with diabetes and stable ischemic heart disease (SIHD) are unclear. Objective To compare the effects of insulin provision (IP) therapy versus insulin sensitizing (IS) therapy for glycemic control in older (≥ 75 years) and younger (< 75 years) adults with type II diabetes (DM) and SIHD. Design, setting, and participants Adults enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) were studied. The BARI 2D study population (all with type II DM and SIHD) was randomized twice: (1) between revascularization plus intensive medical therapy versus intensive medical therapy alone, and (2) between IP versus IS therapies. The primary endpoint was all-cause-mortality over five-year follow-up. In this substudy outcomes related to IP vs. IS are assessed in relation to age. Adults aged ≥ 75 years who received IP versus IS are compared to those < 75 years who received IP versus IS. Multivariate Cox regression analysis was used to evaluate the effects of IP vs. IS on outcomes in the two age groups. Results 2368 subjects with SIHD and DM were enrolled in BARI 2D; 182 (8%) were ≥ 75 years. Compared to younger subjects, the older cohort had lower BMI, higher diuretic use, worse kidney function, and increased history of heart failure. Within the older cohort, the IP and IS subgroups were similar in respect to baseline cardiovascular risk factors, medications, and coronary artery disease severity. During follow-up, the older subjects receiving IP therapy had higher cardiovascular mortality compared to those receiving IS therapy (16% vs. 11%, p = 0.040). Using Cox proportional hazards analysis, the older IP subjects were at increased risk for all-cause-mortality (hazard ratio 1.89, CI 1.1–3.2, p = 0.020). No mortality difference between IP and IS was observed in those < 75 years of age. Conclusion and relevance Among adults with diabetes and SIHD aged ≥ 75 years, IP therapy may be associated with increased mortality compared to IS therapy. Additional studies are needed to further refine optimal treatment strategies for diabetes and SIHD in old age.

KW - BARI 2D

KW - Diabetes mellitus

KW - Elderly

KW - Insulin

KW - Ischemic heart disease

UR - http://www.scopus.com/inward/record.url?scp=85019723199&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019723199&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2017.03.048

DO - 10.1016/j.ijcard.2017.03.048

M3 - Article

C2 - 28314486

AN - SCOPUS:85019723199

VL - 241

SP - 35

EP - 40

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -