Glycemic Control in Type 2 Diabetes: Time for an Evidence-Based About-Face?

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   Figure. Forest plots of trials measuring the effect of intensive glycemic control on macrovascular complications (A), microvascular complications (B), and weight gain and severe hypoglycemia (C).

   For all plots, no difference between intensive and less intensive glycemic control is denoted by the vertical continuous line. UKPDS(a) refers to the main UKPDS trial, which included 2729 patients in the intervention group and 1138 patients in the conventional group. We subdivided the main UKPDS trial in overweight patients with diabetes into 2 comparisons: UKPDS(b), which included 342 overweight patients in the intervention group with metformin and 411 in the conventional group, and UKPDS(c), which included all 1293 overweight patients in the intervention group (metformin, glibenclamide, and insulin) and 411 in the conventional group. When possible, we presented the results using data from UKPDS(c). We calculated the number of cardiovascular deaths in UKPDS(a) by subtracting all noncardiovascular deaths from all reported deaths. When trials used different outcome definitions, the asterisk and dagger identify which trial reported which outcome definition or combination of outcomes (when both symbols accompany the trial name). ACCORD = Action to Control Cardiovascular Risk in Diabetes; ADVANCE = Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation; CGC = conventional glycemic control; IGC = intensive glycemic control; RR = relative risk; UKPDS = United Kingdom Prospective Diabetes Study; VADT = Veterans Affairs Diabetes Trial.