TY - JOUR
T1 - Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes
T2 - a meta-analysis of individual participant data from randomised controlled trials
AU - the
AU - Collaborators on Trials of Lowering Glucose (CONTROL) group
AU - Zoungas, Sophia
AU - Arima, Hisatomi
AU - Gerstein, Hertzel C.
AU - Holman, Rury R.
AU - Woodward, Mark
AU - Reaven, Peter
AU - Hayward, Rodney A.
AU - Craven, Timothy
AU - Coleman, Ruth L.
AU - Chalmers, John
N1 - Funding Information:
SZ is a National Health and Medical Research Council of Australia Senior Research Fellow (1081328). MW is a National Health and Medical Research Council of Australia Principal Research Fellow (1080206). RRH is a National Institute for Health Research Senior Investigator. HCG holds the McMaster-Sanofi Population Health Research Institute Chair in Diabetes Research and Care. RAH is supported by grant P30DK020572 (MDRC) from the National Institute of Diabetes and Digestive and Kidney Diseases. ADVANCE was funded by grants from the National Health and Medical Research Council of Australia (1006367, 358395, and 571281) and from Servier. VADT acknowledges the contributions of the Hines VA Cooperative Studies Program Coordinating Center and was funded in part by the Veterans Affairs Cooperative Studies Program of the US Department of Veterans Affairs Office of Research and Development.
Publisher Copyright:
© 2017 Elsevier Ltd
PY - 2017/6
Y1 - 2017/6
N2 - Background Intensive glucose control is understood to prevent complications in adults with type 2 diabetes. We aimed to more precisely estimate the effects of more intensive glucose control, compared with less intensive glucose control, on the risk of microvascular events. Methods In this meta-analysis, we obtained de-identified individual participant data from large-scale randomised controlled trials assessing the effects of more intensive glucose control versus less intensive glucose control in adults with type 2 diabetes, with at least 1000 patient-years of follow-up in each treatment group and a minimum of 2 years average follow-up on randomised treatment. The prespecified and standardised primary outcomes were kidney events (a composite of end-stage kidney disease, renal death, development of an estimated glomerular filtration rate <30 mL/min per 1·73m2, or development of overt diabetic nephropathy), eye events (a composite of requirement for retinal photocoagulation therapy or vitrectomy, development of proliferative retinopathy, or progression of diabetic retinopathy), and nerve events (a composite of new loss of vibratory sensation, ankle reflexes, or light touch). We used a random-effects model to calculate overall estimates of effect. Findings We included four trials (ACCORD, ADVANCE, UKPDS, and VADT) with 27 049 participants. 1626 kidney events, 795 eye events, and 7598 nerve events were recorded during the follow-up period (median 5·0 years, IQR 4·5–5·0). Compared with less intensive glucose control, more intensive glucose control resulted in an absolute difference of −0·90% (95% CI −1·22 to −0·58) in mean HbA1c at completion of follow-up. The relative risk was reduced by 20% for kidney events (hazard ratio 0·80, 95% CI 0·72 to 0·88; p<0·0001) and by 13% for eye events (0·87, 0·76 to 1·00; p=0·04), but was not reduced for nerve events (0·98, 0·87 to 1·09; p=0·68). Interpretation More intensive glucose control over 5 years reduced both kidney and eye events. Glucose lowering remains important for the prevention of long-term microvascular complications in adults with type 2 diabetes. Funding None.
AB - Background Intensive glucose control is understood to prevent complications in adults with type 2 diabetes. We aimed to more precisely estimate the effects of more intensive glucose control, compared with less intensive glucose control, on the risk of microvascular events. Methods In this meta-analysis, we obtained de-identified individual participant data from large-scale randomised controlled trials assessing the effects of more intensive glucose control versus less intensive glucose control in adults with type 2 diabetes, with at least 1000 patient-years of follow-up in each treatment group and a minimum of 2 years average follow-up on randomised treatment. The prespecified and standardised primary outcomes were kidney events (a composite of end-stage kidney disease, renal death, development of an estimated glomerular filtration rate <30 mL/min per 1·73m2, or development of overt diabetic nephropathy), eye events (a composite of requirement for retinal photocoagulation therapy or vitrectomy, development of proliferative retinopathy, or progression of diabetic retinopathy), and nerve events (a composite of new loss of vibratory sensation, ankle reflexes, or light touch). We used a random-effects model to calculate overall estimates of effect. Findings We included four trials (ACCORD, ADVANCE, UKPDS, and VADT) with 27 049 participants. 1626 kidney events, 795 eye events, and 7598 nerve events were recorded during the follow-up period (median 5·0 years, IQR 4·5–5·0). Compared with less intensive glucose control, more intensive glucose control resulted in an absolute difference of −0·90% (95% CI −1·22 to −0·58) in mean HbA1c at completion of follow-up. The relative risk was reduced by 20% for kidney events (hazard ratio 0·80, 95% CI 0·72 to 0·88; p<0·0001) and by 13% for eye events (0·87, 0·76 to 1·00; p=0·04), but was not reduced for nerve events (0·98, 0·87 to 1·09; p=0·68). Interpretation More intensive glucose control over 5 years reduced both kidney and eye events. Glucose lowering remains important for the prevention of long-term microvascular complications in adults with type 2 diabetes. Funding None.
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U2 - 10.1016/S2213-8587(17)30104-3
DO - 10.1016/S2213-8587(17)30104-3
M3 - Article
C2 - 28365411
AN - SCOPUS:85016474227
SN - 2213-8587
VL - 5
SP - 431
EP - 437
JO - The Lancet Diabetes and Endocrinology
JF - The Lancet Diabetes and Endocrinology
IS - 6
ER -