Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomized controlled trials.

Description

A meta-analysis has been performed to determine whether intensive control of glucose reduced macrovascular events and all-cause mortality in individuals with type 2 diabetes. For that purpose, five randomized clinical trials of 33,040 participants were included in the analysis. HbA1c was 0.9% lower in patients under the intensive treatment than in those under the standard treatment. Intensive glycemic control induced a 17% reduction in nonfatal myocardial infarction (odds ratio: 0.83, 95% CI: 0.75-0.93) and a 15% reduction in coronary heart disease (odds ratio: 0.85, 95% CI: 0.77-0.93). However, intensive glycemic control had no significant impact on stroke or all-cause mortality. This paper was accompanied by an editorial from Dr. Theodore Mazzone in which he mentioned that there is still a need for additional clinical data on the effect of controlling glucose concentrations on coronary heart disease risk in patients with type 2 diabetes. Moreover, he raised the point that on the basis of current information, and the critical need to address residual risk of coronary heart disease in this population, it is premature to conclude that intensive glucose control is not important.