Meta-analysis of effects of intensive blood-glucose control on late complications of type I diabetes*1

WANG, P

doi:10.1016/0140-6736(93)90816-y

Cited by 446Diabetes Management and ResearchDiabetes Treatment and ManagementDiabetes Management and Education

Meta-analysis of effects of intensive blood-glucose control on late complications of type I diabetes*1

WANG, P·1993·The Lancet

DOI 10.1016/0140-6736(93)90816-y

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Abstract

Tight blood glucose control has been speculated to reduce late complications in insulin-dependent diabetics but results from individual studies have been inconsistent. We have done a meta-analysis of sixteen randomised trials of intensive therapy to estimate its impact on the progression of diabetic retinopathy and nephropathy and the risks of severe side-effects. In the intensive therapy group, the risk of retinopathy progression was insignificantly higher after 6-12 months of intensive control (odds ratio [OR] 2.11). After more than two years of intensive therapy the risk of retinopathy progression was lower (OR 0.49 [95% confidence interval 0.28-0.85], p = 0.011). The risk of nephropathy progression was also decreased significantly (OR 0.34 [0.20-0.58], p < 0.001). The incidence of severe hypoglycaemia increased by 9.1 episodes per 100 person-years (95% Cl -1.4 to +19.6) in the intensively treated patients. The incidence of diabetic ketoacidosis increased by 12.6 episodes per 100 person-years (95% Cl, 8.7-16.5) in the patients on continuous subcutaneous insulin infusion. Long-term intensive blood glucose control significantly reduces the risk of diabetic retinopathy and nephropathy progression but long-term continuous subcutaneous insulin infusion was associated with an increased incidence of diabetic ketoacidosis, and intensive therapy may cause more severe hypoglycaemic reactions.

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There is no evidence that intensive glycemic management slows the progression of late microvascular complications of diabetes.
“As there is no evidence that intensive glycemic management slows the progression of late microvascular complications of diabetes, glycemic targets in individuals with advanced complications should be individualized and based on the balance of risks and benefits (39,275).”
From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [275]

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Authors: WANG, P.
Affiliations: Brigham and Women's Hospital (US)
Corresponding author: WANG, P
ORCID: WANG, P
Venue: The Lancet
Publisher: Elsevier BV
Published: 1993-05
Volume: 341
Issue: 8856
Pages: 1306-1309
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/0140-6736(93)90816-y
OpenAlex: W1995937915
Cited by: 446
References: 24
Citations by year: 2026: 3 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 4 · 2020: 10 · 2019: 4 · 2018: 8 · 2017: 8 · 2016: 8 · 2015: 15 · 2014: 17 · 2013: 12 · 2012: 13
FWCI: 9.58
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Funders: Agency for Healthcare Research and Quality (R01 HS-05936)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords: tight glycemic control, type 1 diabetes, diabetic retinopathy progression, diabetic nephropathy progression, hypoglycemia, diabetic ketoacidosis, insulin pump therapy, late complications, insulin therapy
MeSH terms: Blood Glucose, Diabetes Mellitus, Type 1, Diabetic Nephropathies, Diabetic Retinopathy, Humans, Hypoglycemia, Risk Factors, Randomized Controlled Trials as Topic, Diabetic Ketoacidosis

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Meta-analysis of effects of intensive blood-glucose control on late complications of type I diabetes*1

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