Abstract 16367: Treatment With Insulin is Associated With Worse Outcome in Patients With Chronic Heart Failure and Diabetes

Introduction: Up to a third of patients with type-2 diabetes mellitus (T2DM) and heart failure (HF) are treated with insulin. Hypothesis: As insulin causes sodium retention and hypoglycemia, its use might be associated with worse outcomes. Methods: We investigated survival and hospitalization for HF in two datasets: (1) 24,012 patients with heart failure from 4 large randomized trials and (2) an administrative database of 4 million individuals. In the former, survival was examined using Cox proportional hazards models adjusted for baseline variables and separately for propensity scores. Fine-Gray competing risk regression models were used to assess the risk of hospitalization for HF, with death as a competing risk. For the latter, a case-control study nested within the cohort with propensity score was conducted. Results: Prevalence of diabetes at study enrollment ranged from 25.5% to 29.5% across trials. Insulin was prescribed at randomization to 24.4% to 34.5% of those with T2DM. All-cause mortality and ...