AUTHOR=Ke Jiang-Feng , Wang Jun-Wei , Zhang Zhi-Hui , Chen Ming-Yun , Lu Jun-Xi , Li Lian-Xi 

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.599545

DOI=10.3389/fcvm.2021.599545

ISSN=2297-055X

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 2356 hospitalized patients with T2DM, including 1716 subjects with insulin therapy and 640 subjects without 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 with and without insulin therapy.
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)  with insulin therapy than in those without insulin therapy. After further controlling for other confounding factors, compared with the patients without insulin therapy, the risk of carotid plaque was still significantly increased not only in women with insulin therapy (OR: 1.810; 95% CI: 1.155-2.837, p=0.010), but also in men with insulin therapy (OR: 1.867; 95% CI: 1.307-2.666; p=0.001). Additionally, HOMA2-IR and HOMA2-B% was higher in both women and men  without insulin therapy compared with those with insulin therapy (p<0.001 in both men and women), but HOMA-IR was significantly higher in patients with insulin therapy than in those without 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 aggravation of  insulin resistance in T2DM patients with insulin therapy.