Table 4.
Association between diabetes treatment and clinical outcomes in ischemic HFmrEF patients
| Glycemic control regimen | Events/ Total |
Events rate(%) | Non-adjusted | Adjust I | Adjust II | |||
|---|---|---|---|---|---|---|---|---|
| Hazard ratio (95% CI) | P-value | Hazard ratio (95% CI) | P-value | Hazard ratio (95% CI) | P-value | |||
| ALL CAUSE DEATH | ||||||||
| Oral antidiabetic drugs: | ||||||||
| Not on oral medication | 88/241 | 36.51% | Ref. | |||||
| One oral medication | 45/156 | 28.85% | 0.7 (0.5, 1.0) | 0.050 | 0.7 (0.5, 1.0) | 0.047 | 0.7 (0.5, 1.1) | 0.097 |
| Two or more oral medications | 12/70 | 17.14% | 0.4 (0.2, 0.7) | 0.003 | 0.4 (0.2, 0.7) | 0.003 | 0.4 (0.2, 0.8) | 0.007 |
| Insulin/insulin + oral drug: | ||||||||
| Not using insulin | 70/206 | 33.98% | Ref. | |||||
| Using insulin | 75/261 | 28.74% | 0.8 (0.6, 1.2) | 0.316 | 0.7 (0.5, 0.9) | 0.023 | 0.7 (0.5, 0.9) | 0.020 |
| CARDIOVASCULAR EVENT | ||||||||
| Oral antidiabetic drugs: | ||||||||
| Not on oral medication | 187/241 | 77.59% | Ref. | |||||
| One oral medication | 107/156 | 69.87% | 0.7 (0.6, 0.9) | 0.006 | 0.7 (0.6, 0.9) | 0.005 | 0.7 (0.6, 0.9) | 0.016 |
| Two or more oral medications | 44/70 | 62.86% | 0.7 (0.5, 0.9) | 0.022 | 0.7 (0.5, 0.9) | 0.020 | 0.7 (0.5, 1.0) | 0.039 |
| Insulin/insulin + oral drug: | ||||||||
| Not using insulin | 153/206 | 74.27% | Ref. | |||||
| Using insulin | 185/261 | 70.88% | 0.9 (0.7, 1.1) | 0.478 | 0.9 (0.7, 1.1) | 0.356 | 0.9 (0.7, 1.1) | 0.354 |
Statistical significance is indicated by bold values (p < 0.05). Hazard ratios and confidence intervals are presented for each outcome. abbreviations can be found in Table 1.
Non-adjusted model adjust for: None
Adjust I model adjust for: Age; Sex
Adjust II model adjust for: Age; Sex; Angiotensin II Receptor Blockers; Angiotensin Receptor-Neprilysin Inhibitor; Beta-blocker; Spironolactone; Sodium-Glucose Co-Transporter 2 inhibitors; Angiotensin-Converting Enzyme inhibitors.
Clinical interpretation:
- Oral antidiabetic medication: Patients using oral medications (especially two or more drugs) show a significant reduction in all-cause death risk and cardiovascular events. This suggests that optimal glycemic control may improve clinical outcomes in ischemic HFmrEF patients.
- Insulin therapy: Insulin use did not significantly reduce the risk of all-cause death, though it was associated with a reduced risk of cardiovascular events in adjusted models (HR 0.7, p = 0.020), which warrants further investigation