Insulin Therapy Is Associated With an Increased Risk of Carotid Plaque in Type 2 Diabetes: A Real-World Study

Abstract

Background: Controversies concerning the association between insulin therapy and atherosclerotic lesions in type 2 diabetes mellitus (T2DM) remain to exist. The purpose of this study was to investigate whether insulin therapy in T2DM patients is linked with the increased risk of carotid atherosclerosis in real-world settings.Methods: We retrospectively enrolled 2,356 hospitalized patients with T2DM, including 1,716 subjects receiving insulin therapy and 640 subjects without receiving insulin therapy. Carotid atherosclerotic lesions including carotid intima-media thickness (CIMT), carotid plaque and carotid stenosis were assessed by Doppler ultrasonography and were compared between T2DM patients treated with and without insulin.Results: After adjusting for age and duration of diabetes, there was a significant increase in the prevalence of carotid plaque in both men (52.0 vs. 41.7%, p = 0.007) and women (49.6 vs. 39.7%, p = 0.003) receiving insulin therapy than in those without receiving insulin therapy. After further controlling for other confounding factors, compared with the patients without receiving insulin therapy, the risk of carotid plaque was still significantly increased not only in women treated with insulin (OR: 1.810; 95% CI: 1.155–2.837, p = 0.010), but also in men treated with insulin (OR: 1.867; 95% CI: 1.307–2.666; p = 0.001). Additionally, HOMA2-B% was higher in both women and men without receiving insulin therapy compared with those receiving insulin therapy (p < 0.001 in both men and women), but HOMA-IR was significantly higher in patients treated with insulin than in those without receiving insulin therapy (p < 0.001 in both men and women).Conclusions: Insulin therapy is associated with markedly increased risk of carotid atherosclerotic lesions in type 2 diabetes, which partly attribute to the more serious insulin resistance in T2DM patients receiving insulin therapy.

Quantitative Analysis of Myocardial Work by Non-invasive Left Ventricular Pressure-Strain Loop in Patients With Type 2 Diabetes Mellitus

“…In addition, the levels of TG and LDL-C in the T2DM group were higher than those in the NC group. The free fatty acids produced by TG were able to further reduce insulin sensitivity, forming a vicious circle between TG levels and insulin resistance (14)(15)(16).…”

Serum iron is closely associated with metabolic dysfunction-associated fatty liver disease in type 2 diabetes: A real-world study

“…The hospital ethical review committee approved this study [approved number: 2018-KY-018(K)], with written consent obtained from all participants. Inclusion criteria incorporated T2DM diagnosed in accordance with the WHO criteria, age ≥ 17 years old, complete clinical information and biochemical parameters, and available abdominal ultrasound findings ( 25 ). After excluding the patients with disorders related to iron metabolism such as hemochromatosis, iron-deficiency anemia, menstruation within a week, and blood transfusion or donation recently; those with liver diseases caused by drugs, viral hepatitis, and other reasons excluding alcohol; and those with other serious systemic diseases or infectious diseases, 1,467 patients were classified into four groups according to the serum iron quartiles.…”

“…The following data were collected at admission as previously described: hypertension history, diabetes duration (DD), alcohol intake, smoking habits, use of lipid-lowering drugs (LLDs), metformin, insulin sensitizers, insulin or insulin analogs (IIAs), and physical data including height, waist and hip circumference, weight, and blood pressure ( 10 , 11 ). Specifically, the definitions of hypertension, obesity, smoking, and alcohol status were described in our previous studies ( 11 , 25 ).…”

Triglyceride-Glucose Index Is Related to Carotid Plaque and Its Stability in Nondiabetic Adults: A Cross-Sectional Study

“…The TyG index is a reliable alternative marker for IR, which may play an important role in inferring the relationship between TyG and carotid plaque. Many previous studies have demonstrated that IR plays an important role in the development of atherosclerosis and advanced plaque, by promoting increased synthesis and release of lipoproteins, growth and proliferation of vascular smooth muscle cells, and enhanced transport of LDL-C to arterial smooth muscle cells and inflammation ( 9 , 10 , 28 – 30 ). In addition, IR is associated with a group of metabolic abnormalities known as insulin resistance syndrome.…”