Lower incidence of macrovascular complications inpatients on insulin glargine versus those on basal human insulins: A population-based cohort study in Italy

S. Cammarota, D. Bruzzese, A. L. Catapano, A. Citarella, L. De Luca, L. Manzoli, M. Masulli, E. Menditto, A. Mezzetti, S. Riegler, D. Putignano, E. Tragni, E. Novellino, G. Riccardi

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Background and aim: The aim of this study was to compare the use of insulin glargine and intermediate/long-acting human insulin (HI) in relation to the incidence of complications in diabetic patients. Methods and results: A population-based cohort study was conducted using administrative data from four local health authorities in the Abruzzo Region (900,000 inhabitants). Diabetic patients without macrovascular diseases and treated with either intermediate/long-acting HI or glargine were followed for 3-years; the incidence of diabetic (macrovascular, microvascular and metabolic) complications was ascertained by hospital discharge claims and estimated using Cox proportional hazard models. Propensity score (PS) matching was also used to adjust for significant differences in the baseline characteristics between the two groups. Results: Overall, 1921 diabetic patients were included: 744 intermediate/long-acting HI and 1177 glargine users. During the 3-year follow-up, 209 (28.1%) incident events of any diabetic complication occurred in the intermediate/long-acting HI and 159 (13.5%) in the glargine group. After adjustment for covariates, glargine users had an HR (95% CI) of 0.57 (0.44-0.74) for any diabetic complication and HRs of 0.61 (0.44-0.84), 0.58 (0.33-1.04) and 0.35 (0.18-0.70) for macrovascular, microvascular and metabolic complications, respectively, compared to intermediate/long-acting HI users. PS analyses supported these findings. Conclusions: The use of glargine is associated with a lower risk of macrovascular complications compared with traditional basal insulins. However, limitations inherent to the study design including the short length of observation and the lack of data on metabolic control or diabetes duration, do not allow us to consider this association as a proof of causality.

Original languageEnglish
Pages (from-to)10-17
Number of pages8
JournalNutrition, Metabolism and Cardiovascular Diseases
Issue number1
Publication statusPublished - 2014



  • Administrative data
  • Basal human insulins
  • Insulin glargine
  • Macrovascular complications
  • Propensity-score matching

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine

Cite this

Cammarota, S., Bruzzese, D., Catapano, A. L., Citarella, A., De Luca, L., Manzoli, L., Masulli, M., Menditto, E., Mezzetti, A., Riegler, S., Putignano, D., Tragni, E., Novellino, E., & Riccardi, G. (2014). Lower incidence of macrovascular complications inpatients on insulin glargine versus those on basal human insulins: A population-based cohort study in Italy. Nutrition, Metabolism and Cardiovascular Diseases, 24(1), 10-17. https://doi.org/10.1016/j.numecd.2013.04.002