Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials
Summary Background Whether intensive control of glucose reduces macrovascular events and all-cause mortality in individuals with type 2 diabetes mellitus is unclear. We undertook a meta-analysis of randomised controlled trials to determine whether intensive treatment is beneficial. Methods We select...
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| Veröffentlicht in: | The Lancet (British edition) 2009-05, Vol.373 (9677), p.1765-1772 |
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| creator | Ray, Kausik K, Dr Seshasai, Sreenivasa Rao Kondapally, MD Wijesuriya, Shanelle, BA Sivakumaran, Rupa, BA Nethercott, Sarah, BA Preiss, David, MRCP Erqou, Sebhat, MD Sattar, Naveed, Prof |
| description | Summary Background Whether intensive control of glucose reduces macrovascular events and all-cause mortality in individuals with type 2 diabetes mellitus is unclear. We undertook a meta-analysis of randomised controlled trials to determine whether intensive treatment is beneficial. Methods We selected five prospective randomised controlled trials of 33 040 participants to assess the effect of an intensive glucose-lowering regimen on death and cardiovascular outcomes compared with a standard regimen. We gathered information about events of non-fatal myocardial infarction, coronary heart disease (fatal and non-fatal myocardial infarction), stroke, and all-cause mortality, and did a random-effects meta-analysis to obtain summary effect estimates for the clinical outcomes with use of odds ratios calculated from the raw data of every trial. Statistical heterogeneity across trials was assessed with the χ2 and I2 statistics. Findings The five trials provided information on 1497 events of non-fatal myocardial infarction, 2318 of coronary heart disease, 1127 of stroke, and 2892 of all-cause mortality during about 163 000 person-years of follow-up. The mean haemoglobin A1c concentration (HbA1c ) was 0·9% lower for participants given intensive treatment than for those given standard treatment. Intensive glycaemic control resulted in a 17% reduction in events of non-fatal myocardial infarction (odds ratio 0·83, 95% CI 0·75–0·93), and a 15% reduction in events of coronary heart disease (0·85, 0·77–0·93). Intensive glycaemic control had no significant effect on events of stroke (0·93, 0·81–1·06) or all-cause mortality (1·02, 0·87–1·19). Interpretation Overall, intensive compared with standard glycaemic control significantly reduces coronary events without an increased risk of death. However, the optimum mechanism, speed, and extent of HbA1c reduction might be different in differing populations. Funding None. |
| doi_str_mv | 10.1016/S0140-6736(09)60697-8 |
| format | Article |
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We undertook a meta-analysis of randomised controlled trials to determine whether intensive treatment is beneficial. Methods We selected five prospective randomised controlled trials of 33 040 participants to assess the effect of an intensive glucose-lowering regimen on death and cardiovascular outcomes compared with a standard regimen. We gathered information about events of non-fatal myocardial infarction, coronary heart disease (fatal and non-fatal myocardial infarction), stroke, and all-cause mortality, and did a random-effects meta-analysis to obtain summary effect estimates for the clinical outcomes with use of odds ratios calculated from the raw data of every trial. Statistical heterogeneity across trials was assessed with the χ2 and I2 statistics. Findings The five trials provided information on 1497 events of non-fatal myocardial infarction, 2318 of coronary heart disease, 1127 of stroke, and 2892 of all-cause mortality during about 163 000 person-years of follow-up. The mean haemoglobin A1c concentration (HbA1c ) was 0·9% lower for participants given intensive treatment than for those given standard treatment. Intensive glycaemic control resulted in a 17% reduction in events of non-fatal myocardial infarction (odds ratio 0·83, 95% CI 0·75–0·93), and a 15% reduction in events of coronary heart disease (0·85, 0·77–0·93). Intensive glycaemic control had no significant effect on events of stroke (0·93, 0·81–1·06) or all-cause mortality (1·02, 0·87–1·19). Interpretation Overall, intensive compared with standard glycaemic control significantly reduces coronary events without an increased risk of death. However, the optimum mechanism, speed, and extent of HbA1c reduction might be different in differing populations. Funding None.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(09)60697-8</identifier><identifier>PMID: 19465231</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Biological and medical sciences ; Blood Glucose - metabolism ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - prevention & control ; Cause of Death ; Clinical outcomes ; Clinical trials ; Deaths ; Diabetes ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - mortality ; Diabetes Mellitus, Type 2 - prevention & control ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; General aspects ; Glucose ; Glycated Hemoglobin A - metabolism ; Heart attacks ; Heterogeneity ; Humans ; Internal Medicine ; Male ; Medical sciences ; Middle Aged ; Mortality ; Multicenter Studies as Topic ; Myocardial infarction ; Odds Ratio ; Patients ; Proportional Hazards Models ; Prospective Studies ; Randomized Controlled Trials as Topic ; Research Design ; Risk Factors ; Risk Reduction Behavior ; Sensitivity and Specificity ; Systematic review ; Treatment Outcome</subject><ispartof>The Lancet (British edition), 2009-05, Vol.373 (9677), p.1765-1772</ispartof><rights>Elsevier Ltd</rights><rights>2009 Elsevier Ltd</rights><rights>2009 INIST-CNRS</rights><rights>Copyright Elsevier Limited May 23-May 29, 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-c52dd68acc669c71db29a5e6a9bbb6a8981228623fc2fba8ff785c99597eb7373</citedby><cites>FETCH-LOGICAL-c475t-c52dd68acc669c71db29a5e6a9bbb6a8981228623fc2fba8ff785c99597eb7373</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0140673609606978$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21480263$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19465231$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ray, Kausik K, Dr</creatorcontrib><creatorcontrib>Seshasai, Sreenivasa Rao Kondapally, MD</creatorcontrib><creatorcontrib>Wijesuriya, Shanelle, BA</creatorcontrib><creatorcontrib>Sivakumaran, Rupa, BA</creatorcontrib><creatorcontrib>Nethercott, Sarah, BA</creatorcontrib><creatorcontrib>Preiss, David, MRCP</creatorcontrib><creatorcontrib>Erqou, Sebhat, MD</creatorcontrib><creatorcontrib>Sattar, Naveed, Prof</creatorcontrib><title>Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Summary Background Whether intensive control of glucose reduces macrovascular events and all-cause mortality in individuals with type 2 diabetes mellitus is unclear. We undertook a meta-analysis of randomised controlled trials to determine whether intensive treatment is beneficial. Methods We selected five prospective randomised controlled trials of 33 040 participants to assess the effect of an intensive glucose-lowering regimen on death and cardiovascular outcomes compared with a standard regimen. We gathered information about events of non-fatal myocardial infarction, coronary heart disease (fatal and non-fatal myocardial infarction), stroke, and all-cause mortality, and did a random-effects meta-analysis to obtain summary effect estimates for the clinical outcomes with use of odds ratios calculated from the raw data of every trial. Statistical heterogeneity across trials was assessed with the χ2 and I2 statistics. Findings The five trials provided information on 1497 events of non-fatal myocardial infarction, 2318 of coronary heart disease, 1127 of stroke, and 2892 of all-cause mortality during about 163 000 person-years of follow-up. The mean haemoglobin A1c concentration (HbA1c ) was 0·9% lower for participants given intensive treatment than for those given standard treatment. Intensive glycaemic control resulted in a 17% reduction in events of non-fatal myocardial infarction (odds ratio 0·83, 95% CI 0·75–0·93), and a 15% reduction in events of coronary heart disease (0·85, 0·77–0·93). Intensive glycaemic control had no significant effect on events of stroke (0·93, 0·81–1·06) or all-cause mortality (1·02, 0·87–1·19). Interpretation Overall, intensive compared with standard glycaemic control significantly reduces coronary events without an increased risk of death. However, the optimum mechanism, speed, and extent of HbA1c reduction might be different in differing populations. Funding None.</description><subject>Biological and medical sciences</subject><subject>Blood Glucose - metabolism</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cardiovascular Diseases - etiology</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Cause of Death</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Deaths</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - mortality</subject><subject>Diabetes Mellitus, Type 2 - prevention & control</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Female</subject><subject>General aspects</subject><subject>Glucose</subject><subject>Glycated Hemoglobin A - metabolism</subject><subject>Heart attacks</subject><subject>Heterogeneity</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multicenter Studies as Topic</subject><subject>Myocardial infarction</subject><subject>Odds Ratio</subject><subject>Patients</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Research Design</subject><subject>Risk Factors</subject><subject>Risk Reduction Behavior</subject><subject>Sensitivity and Specificity</subject><subject>Systematic review</subject><subject>Treatment Outcome</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkcuKFDEUhgtRnHb0EZQgKLooTVKVmwtFhvECAy5UcBdSyYlmrK60Saqln8ZXNdXdzsBsXJ1D-PKdk_xN85DgFwQT_vIzJj1uuej4M6yec8yVaOWtZkV60besF99uN6sr5KS5l_MlxrjnmN1tTojqOaMdWTV_zr0HW1D0KEwFphy2gGycSorjcvh9nG3MgOKErEkuxK3Jdh5NQnEuNq4hIzM55MCUH9WANqYEmEpGv0M9cMEMUCqzhnEMZc6vkKl9Ma2ZzLjLIS8zUjXEdcjg_k0ea1tSMGO-39zxtcCDYz1tvr47_3L2ob349P7j2duL1vaCldYy6hyXxlrOlRXEDVQZBtyoYRi4kUoSSiWnnbfUD0Z6LySzSjElYBCd6E6bpwfvJsVfM-Si60K2bm0miHPWXFBBJJYVfHwDvIxzqq_JmiiFeyY7ViF2gGyKOSfwepPC2qSdJlgv8el9fHrJRmOl9_HpRf7oKJ-HNbjrW8e8KvDkCNQYzOjr19mQrzhKeokp7yr35sBB_bNtgKSzrblYcCHVuLWL4b-rvL5hsGOYQh36E3aQrx-tM9X4IFkcWO0NsvsLva7Pbw</recordid><startdate>20090523</startdate><enddate>20090523</enddate><creator>Ray, Kausik K, Dr</creator><creator>Seshasai, Sreenivasa Rao Kondapally, MD</creator><creator>Wijesuriya, Shanelle, BA</creator><creator>Sivakumaran, Rupa, BA</creator><creator>Nethercott, Sarah, BA</creator><creator>Preiss, David, MRCP</creator><creator>Erqou, Sebhat, MD</creator><creator>Sattar, Naveed, Prof</creator><general>Elsevier Ltd</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20090523</creationdate><title>Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials</title><author>Ray, Kausik K, Dr ; Seshasai, Sreenivasa Rao Kondapally, MD ; Wijesuriya, Shanelle, BA ; Sivakumaran, Rupa, BA ; Nethercott, Sarah, BA ; Preiss, David, MRCP ; Erqou, Sebhat, MD ; Sattar, Naveed, Prof</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-c52dd68acc669c71db29a5e6a9bbb6a8981228623fc2fba8ff785c99597eb7373</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Biological and medical sciences</topic><topic>Blood Glucose - metabolism</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Cardiovascular Diseases - etiology</topic><topic>Cardiovascular Diseases - prevention & control</topic><topic>Cause of Death</topic><topic>Clinical outcomes</topic><topic>Clinical trials</topic><topic>Deaths</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - blood</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - mortality</topic><topic>Diabetes Mellitus, Type 2 - prevention & control</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Female</topic><topic>General aspects</topic><topic>Glucose</topic><topic>Glycated Hemoglobin A - metabolism</topic><topic>Heart attacks</topic><topic>Heterogeneity</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multicenter Studies as Topic</topic><topic>Myocardial infarction</topic><topic>Odds Ratio</topic><topic>Patients</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Research Design</topic><topic>Risk Factors</topic><topic>Risk Reduction Behavior</topic><topic>Sensitivity and Specificity</topic><topic>Systematic review</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ray, Kausik K, Dr</creatorcontrib><creatorcontrib>Seshasai, Sreenivasa Rao Kondapally, 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Prof</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2009-05-23</date><risdate>2009</risdate><volume>373</volume><issue>9677</issue><spage>1765</spage><epage>1772</epage><pages>1765-1772</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Summary Background Whether intensive control of glucose reduces macrovascular events and all-cause mortality in individuals with type 2 diabetes mellitus is unclear. We undertook a meta-analysis of randomised controlled trials to determine whether intensive treatment is beneficial. Methods We selected five prospective randomised controlled trials of 33 040 participants to assess the effect of an intensive glucose-lowering regimen on death and cardiovascular outcomes compared with a standard regimen. We gathered information about events of non-fatal myocardial infarction, coronary heart disease (fatal and non-fatal myocardial infarction), stroke, and all-cause mortality, and did a random-effects meta-analysis to obtain summary effect estimates for the clinical outcomes with use of odds ratios calculated from the raw data of every trial. Statistical heterogeneity across trials was assessed with the χ2 and I2 statistics. Findings The five trials provided information on 1497 events of non-fatal myocardial infarction, 2318 of coronary heart disease, 1127 of stroke, and 2892 of all-cause mortality during about 163 000 person-years of follow-up. The mean haemoglobin A1c concentration (HbA1c ) was 0·9% lower for participants given intensive treatment than for those given standard treatment. Intensive glycaemic control resulted in a 17% reduction in events of non-fatal myocardial infarction (odds ratio 0·83, 95% CI 0·75–0·93), and a 15% reduction in events of coronary heart disease (0·85, 0·77–0·93). Intensive glycaemic control had no significant effect on events of stroke (0·93, 0·81–1·06) or all-cause mortality (1·02, 0·87–1·19). Interpretation Overall, intensive compared with standard glycaemic control significantly reduces coronary events without an increased risk of death. However, the optimum mechanism, speed, and extent of HbA1c reduction might be different in differing populations. Funding None.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>19465231</pmid><doi>10.1016/S0140-6736(09)60697-8</doi><tpages>8</tpages></addata></record> |
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| ispartof | The Lancet (British edition), 2009-05, Vol.373 (9677), p.1765-1772 |
| issn | 0140-6736 1474-547X |
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| subjects | Biological and medical sciences Blood Glucose - metabolism Cardiovascular disease Cardiovascular diseases Cardiovascular Diseases - epidemiology Cardiovascular Diseases - etiology Cardiovascular Diseases - prevention & control Cause of Death Clinical outcomes Clinical trials Deaths Diabetes Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - mortality Diabetes Mellitus, Type 2 - prevention & control Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female General aspects Glucose Glycated Hemoglobin A - metabolism Heart attacks Heterogeneity Humans Internal Medicine Male Medical sciences Middle Aged Mortality Multicenter Studies as Topic Myocardial infarction Odds Ratio Patients Proportional Hazards Models Prospective Studies Randomized Controlled Trials as Topic Research Design Risk Factors Risk Reduction Behavior Sensitivity and Specificity Systematic review Treatment Outcome |
| title | Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials |
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