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

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

WANG, P·1993·The Lancet

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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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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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