Cited by 358Diabetes Treatment and ManagementDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

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Systematic Review: Glucose Control and Cardiovascular Disease in Type 2 Diabetes

Kelly, Tanika N., Bazzano, Lydia A., Fonseca, Vivian A., Thethi, Tina K., Reynolds, Kristi, He, Jiang·2009·Annals of Internal Medicine

DOI 10.7326/0003-4819-151-6-200909150-00137PMC PMC3058557

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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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Self-citation
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“Significant heterogeneity was noted across trials (UKPDS 33, UKPDS 34, ACCORD, ADVANCE, and VADT) for cardiovascular mortality and all-cause mortality.(31) Another meta-analysis included one additional trial (PROACTIVE(32)) for a total of 33 040 patients with 163 000 person-years of follow-up: intensive glycaemic cont…”
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Background
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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.
ORCID: Kelly, Tanika N.
Bazzano, Lydia A.
Fonseca, Vivian A.
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
DOI: 10.7326/0003-4819-151-6-200909150-00137
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
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
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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Systematic Review: Glucose Control and Cardiovascular Disease in Type 2 Diabetes

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