Vijaykumar Lingegowda, MD, MSEd, FASN
In patients with type 2 diabetes mellitus (DM), does intensive glucose lowering reduce all-cause and cardiovascular (CV) mortality?
Included studies compared intensive glucose lowering (oral or insulin) with less intensive glucose lowering, usual care, or placebo in adults with type 2 DM. Outcomes included all-cause and CV mortality, myocardial infarction (MI), stroke , congestive heart failure (CHF), visual deterioration or blindness, new or worsening neuropathy, and renal failure or doubling of serum creatinine level.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Database of Systematic Reviews (all 1950 to Jul 2010), and reference lists of published meta-analyses were searched for randomized controlled trials (RCTs). 13 RCTs (n = 34 533, mean age 62 y, 60% men) met the selection criteria. Mean duration of follow-up was 5 years. 5 studies were considered high-quality (Jadad score ≥ 4 out of 5).
Mean final glycated hemoglobin (HbA1c) levels were 6.4% to 7.7% in the intensive group and 7.3% to 9.5% in the control group. Intensive glucose control reduced nonfatal MI, but groups did not differ for all-cause or CV mortality, all MIs, stroke, CHF, visual deterioration or blindness, new or worsening neuropathy, or renal failure or doubling of serum creatinine level (Table).
In patients with type 2 diabetes mellitus, intensive glucose lowering does not reduce all-cause or cardiovascular mortality.
*MI = myocardial infarction, NS = not significant; other abbreviations defined in Glossary. RRI, RRR, NNH, NNT, CI, and weighted IGL event rates calculated from risk ratios and control event rates in article.
†Renal failure or doubling of serum creatinine level.
Lingegowda V. Review: Intensive glucose lowering does not reduce mortality in type 2 diabetes. Ann Intern Med. ;155:JC6–4. doi: 10.7326/0003-4819-155-12-201112200-02004
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Published: Ann Intern Med. 2011;155(12):JC6-4.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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