The DOI matches its Crossref record; 23 of the 24 references it cites were found in a registry or an index.
Meta-analysis of effects of intensive blood-glucose control on late complications of type I diabetes*1
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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“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).”
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Metadata
- 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
- 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
- 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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