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Systematic Review: Glucose Control and Cardiovascular Disease in Type 2 Diabetes
- Tanika N. Kelly, PhD;
- Lydia A. Bazzano, MD, PhD;
- Vivian A. Fonseca, MD;
- Tina K. Thethi, MD;
- Kristi Reynolds, PhD; and
- Jiang He, MD, PhD
- From Tulane University School of Public Health and Tropical Medicine and Tulane University School of Medicine, New Orleans, Louisiana, and Kaiser Permanente Southern California, Pasadena, California.
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.
Article and Author Information
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Grant Support: Dr. Bazzano was supported by career development award 1K08HL091108 from the National Heart, Lung, and Blood Institute. Dr. Thethi was supported by award K12HD043451 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Tanika N. Kelly, PhD, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA 70112; e-mail, tkelly{at}tulane.edu.
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Current Author Addresses: Drs. Kelly and Bazzano: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA 70112.
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Drs. Fonseca and Thethi: Department of Medicine, Section of Endocrinology, Tulane University Health Sciences Center, 1430 Tulane Avenue, SL-53, New Orleans, LA 70112.
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Dr. Reynolds: Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, 2nd Floor, Pasadena, CA 91101.
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Dr. He: Department of Epidemiology, Tulane University Health Sciences Center, 1430 Tulane Avenue, SL-18, New Orleans, LA 70112.
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