Lorraine L. Lipscombe, MD, MSc, FRCPC
Does intensive glucose control reduce cardiovascular (CV) events and mortality in patients with type 2 diabetes mellitus?
Included studies compared intensive glucose-lowering regimens with standard regimens (placebo, standard care, or reduced-intensity control) in stable patients with type 2 diabetes mellitus, had significant group differences in hemoglobin A1c (HbA1c) levels during follow-up, reported CV events as primary outcomes, and provided adequate data for outcomes of interest: nonfatal myocardial infarction (MI), coronary heart disease (CHD), stroke, and all-cause mortality. Other outcomes included HbA1c levels, heart failure (HF), hypoglycemia, and weight gain.
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central (all 1970 to Jan 2009) and reference lists were searched for randomized controlled trials (RCTs). Experts were contacted. 5 RCTs (n = 33 040, mean age 62 y, 62% men) met the selection criteria. Intensive glucose control regimens varied.
The main results are in the Table. Mean HbA1c level at baseline was 7.8% (range 7.1% to 9.4%). At a mean 5 years of follow-up, intensive glucose control reduced HbA1c levels more than standard control (mean 6.6% vs 7.5%, difference 0.9%, 95% CI 0.88 to 0.92). Intensive glucose control was associated with more serious hypoglycemic events than standard control (mean 2.3% vs 1.2%, P value not reported) and increased weight gain (mean 2.4 kg vs −0.1 kg, P value not reported).
In patients with type 2 diabetes mellitus, intensive glucose control reduced some cardiovascular events but did not change overall mortality.
Intensive vs standard glucose control in type 2 diabetes*
* CHD = coronary heart disease; MI = myocardial infarction; other abbreviations defined in Glossary. All results based on 5 trials (n = 33 040). RRR, RRI, NNT, NNH, and CI calculated from data in article using a random-effects model.
†Results were heterogeneous.
Lipscombe LL. Review: Intensive glucose control reduced some CV events but did not change mortality in type 2 diabetes. Ann Intern Med. ;151:JC3–6. doi: 10.7326/0003-4819-151-6-200909150-02006
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Published: Ann Intern Med. 2009;151(6):JC3-6.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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