Evidence map›Paper›PMID 34496864›Full record

Observational studyCardiovascular diabetology2021

Impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus.

Se Yong Jang, Jieun Jang, Dong Heon Yang, Hyun-Jai Cho, Soo Lim, Eun-Seok Jeon, Sang Eun Lee, Jae-Joong Kim, Seok-Min Kang, Sang Hong Baek and 6 more

Open access · goldAbstract readComparative StudyMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Cardiovascular diabetology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 1 pooled it
3.1field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.

  1. Pooled it
  2. SESC heart failure · 2024
    Trial
  3. Observational
  4. Review
  5. Article
  6. Article
  7. Article
  8. Article
  9. Article
  10. Heart Failure and Diabetes Mellitus: Dangerous Liaisons.International journal of heart failure · 2022
    Review
  11. Review
  12. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 12 institutions in 3 countries.

Se Yong Jang *Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Jieun Jang *Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Dong Heon YangDepartment of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Hyun-Jai ChoDepartment of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Soo LimDepartment of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Eun-Seok JeonDepartment of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.
Sang Eun LeeDepartment of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Jae-Joong KimDepartment of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Seok-Min KangDepartment of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Sang Hong BaekDepartment of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Myeong-Chan ChoDepartment of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
Dong-Ju ChoiDepartment of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Byung-Su YooDepartment of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Kye Hun KimDepartment of Internal Medicine, Heart Research Center of Chonnam National University, Gwangju, Republic of Korea.
Sue K ParkDepartment of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Hae-Young LeeDepartment of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. hylee612@snu.ac.kr.ORCID 0000-0002-9521-4102
Kyungpook National University · KRSeoul National University Bundang Hospital · KRUlsan College · KRYonsei University · KRCatholic University of Korea · KRChonnam National University · KRChungbuk National University · KRKorea University · KRNew Generation University College · ETSeoul National University · KRSeoul National University Hospital · KRSungkyunkwan University · KR

Funding

Korea Centers for Disease Control and Prevention 2010-E63003-00Korea Centers for Disease Control and Prevention 2011-E63002-00Korea Centers for Disease Control and Prevention 2012-E63005-00Korea Centers for Disease Control and Prevention 2013-E63003-00Korea Centers for Disease Control and Prevention 2013-E63003-01Korea Centers for Disease Control and Prevention 2013-E63003-02Korea Centers for Disease Control and Prevention 2016-ER6303-00
6 · The paper itself

Abstract

backgroundPatients with diabetes mellitus (DM) have a higher prevalence of heart failure (HF) than those without it. Approximately 40 % of HF patients have DM and they tend to have poorer outcomes than those without DM. This study evaluated the impact of insulin therapy on mortality among acute HF patients.

methodsA total of 1740 patients from the Korean Acute Heart Failure registry with DM were included in this study. The risk of all-cause mortality according to insulin therapy was assessed using the Cox proportional hazard models with inverse probability of treatment weighting to balance the clinical characteristics (pretreatment covariates) between the groups.

resultsDM patients had been treated with either oral hypoglycemic agents (OHAs) alone (n = 620), insulin alone (n = 682), or insulin combined with OHAs (n = 438). The insulin alone group was associated with an increased mortality risk compared with the OHA alone group (HR = 1.41, 95 % CI 1.21-1.66]). Insulin therapy combined with OHAs also showed an increased mortality risk (HR = 1.29, 95 % CI 1.14-1.46) compared with the OHA alone group. Insulin therapy was consistently associated with increased mortality risk, regardless of the left ventricular ejection fraction (LVEF) or HF etiology. A significant increase in mortality was observed in patients with good glycemic control (HbA1c < 7.0 %) receiving insulin, whereas there was no significant association in patients with poor glycemic control (HbA1c ≥ 7.0%).

conclusionsInsulin therapy was found to be associated with increased mortality compared to OHAs. The insulin therapy was harmful especially in patients with low HbA1c levels which may suggest the necessity of specific management strategies and blood sugar targets when using insulin in patients with HF.

Indexed as

Glycemic ControlAcute DiseaseAgedAged, 80 and overBiomarkersBlood GlucoseDiabetes MellitusFemaleGlycated HemoglobinHeart FailureHumansHypoglycemic AgentsInsulinMaleMiddle AgedProspective StudiesBiomarkersBlood GlucoseGlycated Hemoglobinhemoglobin A1c protein, humanHypoglycemic AgentsInsulinDiabetes mellitusHeart failureInsulinMortality

Identifiers

PMID34496864
PMCPMC8424885
OpenAlexW3197347343

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.