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The long-term effects of insulin use in incident cystic fibrosis-related diabetes: a target trial emulated using longitudinal national registry data
INTRODUCTION: Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis and is associated with deleterious clinical outcomes. Insulin is recommended as a treatment by international guidelines. However, there are scarce clinical trial data to support the use of insulin, and...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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European Respiratory Society
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9638829/ https://www.ncbi.nlm.nih.gov/pubmed/36382232 http://dx.doi.org/10.1183/23120541.00170-2022 |
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author | Granger, Emily Keogh, Ruth H. Frost, Freddy |
author_facet | Granger, Emily Keogh, Ruth H. Frost, Freddy |
author_sort | Granger, Emily |
collection | PubMed |
description | INTRODUCTION: Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis and is associated with deleterious clinical outcomes. Insulin is recommended as a treatment by international guidelines. However, there are scarce clinical trial data to support the use of insulin, and little is known about the long-term outcomes of treatment. The aim of this study was to compare the long-term impacts of insulin use versus non-use in CFRD. METHODS: We used data from the national UK Cystic Fibrosis Registry and adopted a target trial framework. Eligible individuals included those 12 years and older with a new diagnosis of CFRD. Outcomes were change in % predicted forced expiratory volume in 1 s (FEV(1) %) and body mass index z-scores (BMI) over a 5-year follow-up period. Treatment strategies were to receive insulin or not for the duration of follow-up. Treatment effect estimates were obtained using two methods to control for confounding: inverse-probability-of-treatment weighted estimation of marginal structural models and the G-formula. RESULTS: We identified 1613 individuals diagnosed with CFRD between 2008 and 2016 and included 1196 and 1192 in the FEV(1) % and BMI outcome analyses respectively. We found no evidence of an effect of insulin on FEV(1) % over the 5-year study period. Similarly, we found no overall effect of insulin on BMI; however, there was some evidence for a positive treatment effect in patients with lower baseline BMI. CONCLUSION: Using well-established national registry data, we found no evidence of long-term treatment effects for insulin on FEV(1) % or BMI in people with incident CFRD. |
format | Online Article Text |
id | pubmed-9638829 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-96388292022-11-14 The long-term effects of insulin use in incident cystic fibrosis-related diabetes: a target trial emulated using longitudinal national registry data Granger, Emily Keogh, Ruth H. Frost, Freddy ERJ Open Res Original Research Articles INTRODUCTION: Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis and is associated with deleterious clinical outcomes. Insulin is recommended as a treatment by international guidelines. However, there are scarce clinical trial data to support the use of insulin, and little is known about the long-term outcomes of treatment. The aim of this study was to compare the long-term impacts of insulin use versus non-use in CFRD. METHODS: We used data from the national UK Cystic Fibrosis Registry and adopted a target trial framework. Eligible individuals included those 12 years and older with a new diagnosis of CFRD. Outcomes were change in % predicted forced expiratory volume in 1 s (FEV(1) %) and body mass index z-scores (BMI) over a 5-year follow-up period. Treatment strategies were to receive insulin or not for the duration of follow-up. Treatment effect estimates were obtained using two methods to control for confounding: inverse-probability-of-treatment weighted estimation of marginal structural models and the G-formula. RESULTS: We identified 1613 individuals diagnosed with CFRD between 2008 and 2016 and included 1196 and 1192 in the FEV(1) % and BMI outcome analyses respectively. We found no evidence of an effect of insulin on FEV(1) % over the 5-year study period. Similarly, we found no overall effect of insulin on BMI; however, there was some evidence for a positive treatment effect in patients with lower baseline BMI. CONCLUSION: Using well-established national registry data, we found no evidence of long-term treatment effects for insulin on FEV(1) % or BMI in people with incident CFRD. European Respiratory Society 2022-11-07 /pmc/articles/PMC9638829/ /pubmed/36382232 http://dx.doi.org/10.1183/23120541.00170-2022 Text en Copyright ©The authors 2022 https://creativecommons.org/licenses/by/4.0/This version is distributed under the terms of the Creative Commons Attribution Licence 4.0. |
spellingShingle | Original Research Articles Granger, Emily Keogh, Ruth H. Frost, Freddy The long-term effects of insulin use in incident cystic fibrosis-related diabetes: a target trial emulated using longitudinal national registry data |
title | The long-term effects of insulin use in incident cystic fibrosis-related diabetes: a target trial emulated using longitudinal national registry data |
title_full | The long-term effects of insulin use in incident cystic fibrosis-related diabetes: a target trial emulated using longitudinal national registry data |
title_fullStr | The long-term effects of insulin use in incident cystic fibrosis-related diabetes: a target trial emulated using longitudinal national registry data |
title_full_unstemmed | The long-term effects of insulin use in incident cystic fibrosis-related diabetes: a target trial emulated using longitudinal national registry data |
title_short | The long-term effects of insulin use in incident cystic fibrosis-related diabetes: a target trial emulated using longitudinal national registry data |
title_sort | long-term effects of insulin use in incident cystic fibrosis-related diabetes: a target trial emulated using longitudinal national registry data |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9638829/ https://www.ncbi.nlm.nih.gov/pubmed/36382232 http://dx.doi.org/10.1183/23120541.00170-2022 |
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