Pharmacotherapy for Diabetes and Stroke Risk: Results from ROCKET AF

Abstract Background Insulin use may be a better predictor of stroke risk and morbidity and mortality than diabetes in patients with atrial fibrillation. Objectives Determine if the increased risk of stroke observed in patients with AF and diabetes is restricted to those treated with insulin. Methods We analyzed the association between diabetes and treatment and the occurrence of stroke/systemic embolism, myocardial infarction, all-cause death, vascular death, composite outcomes, and bleeding risk in the ROCKET AF trial. Results In a cohort of 14,264 patients, 40.3% (n=5,746) with diabetes; 5.9% (n=842) on insulin, 18.9% (n=2697) on oral medications, and 11.9% (n=1,703) diet-controlled. Compared to those without diabetes, patients with non–insulin-treated diabetes had increased risks of stroke (HR 1.33, 95% CI 1.06–1.68), MI (HR 1.64, 95% CI 1.17–2.30), ACD (HR 1.26, 95% CI 1.08–1.46), vascular death (HR 1.33, 95% CI 1.11–1.60), and composite outcomes (HR 1.37, 95% CI 1.18–1.157). Patients with insulin-treated diabetes had a significantly higher risk of MI (HR 2.31, 95% CI 1.33–4.01) and composite outcomes (HR 1.57, 95% CI 1.19–2.08) compared with those without diabetes. There were no significant differences between insulin-treated versus non–insulin-treated diabetes for any outcome. Conclusion Among patients with AF and diabetes, there were no significant differences in outcomes in insulin-treated diabetes compared with non–insulin-treated diabetes.