Systematic review: glucose control and cardiovascular disease in type 2 diabetes
Abstract
BACKGROUND: Results from clinical trials examining the effect of intensive glucose control on cardiovascular disease have been conflicting. PURPOSE: To summarize clinical benefits and harms of intensive versus conventional glucose control for adults with type 2 diabetes. DATA SOURCES: Studies were retrieved by systematically searching the MEDLINE database (January 1950 to April 2009) with no language restrictions. STUDY SELECTION: Two independent reviewers screened abstracts or full-text articles to identify randomized trials that compared clinical outcomes in patients with type 2 diabetes receiving intensive glucose control and those receiving conventional glucose control. DATA EXTRACTION: Two investigators independently abstracted data on study variables and outcomes, including severe hypoglycemia, cardiovascular disease, and all-cause mortality. DATA SYNTHESIS: 5 trials involving 27,802 adults were included. Intensive glucose targets were lower in the 3 most recent trials. Summary analyses showed that compared with conventional control, intensive glucose control reduced the risk for cardiovascular disease (relative risk [RR], 0.90 [95% CI, 0.83 to 0.98]; risk difference per 1000 patients per 5 years [RD], -15 [CI, -24 to -5]) but not cardiovascular death (RR, 0.97 [CI, 0.76 to 1.24]; RD, -3 [CI, -14 to 7]) or all-cause mortality (RR, 0.98 [CI, 0.84 to 1.15]; RD, -4 [CI, -17 to 10]). Intensive glucose control increased the risk for severe hypoglycemia (RR, 2.03 [CI, 1.46 to 2.81]; RD, 39 [CI, 7 to 71]). As was seen in the overall analyses, pooled findings from the early and more recent trials showed that intensive glucose control reduced the risk for cardiovascular disease and increased the risk for severe hypoglycemia. LIMITATION: Summary rather than individual data were pooled across trials. CONCLUSION: Intensive glucose control reduced the risk for some cardiovascular disease outcomes (such as nonfatal myocardial infarction), did not reduce the risk for cardiovascular death or all-cause mortality, and increased the risk for severe hypoglycemia.
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- Authors
- Kelly, T. N., Bazzano, L. A., Fonseca, V. A., Thethi, T. K., Reynolds, K., & He, J.
- Affiliations
- Tulane University (US)
- Corresponding author
- Kelly, Tanika N.
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2009-09-15
- Volume
- 151
- Issue
- 6
- Pages
- 394-403
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC3058557
- OpenAlex
- W2166180770
- Cited by
- 358
- References
- 43
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 7 · 2021: 18 · 2020: 16 · 2019: 10 · 2018: 16 · 2017: 16 · 2016: 21 · 2015: 28 · 2014: 29 · 2013: 29 · 2012: 40
- FWCI
- 6.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K08HL091108)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD043451)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, tight glycemic control, glycemic targets, cardiovascular disease, cardiovascular mortality, all-cause mortality, severe hypoglycemia, myocardial infarction, glycemic control
- MeSH terms
- Blood Glucose, Cardiovascular Diseases, Cause of Death, Diabetes Mellitus, Type 2, Humans, Hypoglycemia, Hypoglycemic Agents, Risk Factors
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