schliessen

Filtern

 

Bibliotheken

Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials

Objective To determine all cause mortality and deaths from cardiovascular events related to intensive glucose lowering treatment in people with type 2 diabetes.Design Meta-analysis of randomised controlled trials.Data sources Medline, Embase, and the Cochrane database of systematic reviews.Study sel... Full description

Journal Title: BMJ 2011-07-26, Vol.343 (7817), p.2070-d4169
Main Author: Boussageon, Rémy
Other Authors: Bejan-Angoulvant, Theodora , Saadatian-Elahi, Mitra , Lafont, Sandrine , Bergeonneau, Claire , Kassaï, Behrouz , Erpeldinger, Sylvie , Wright, James M , Gueyffier, François , Cornu, Catherine
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: England: British Medical Journal Publishing Group
ID: ISSN: 0959-8138
Zum Text:
SendSend as email Add to Book BagAdd to Book Bag
Staff View
recordid: cdi_hal_primary_oai_HAL_hal_00698409v1
title: Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials
format: Article
creator:
  • Boussageon, Rémy
  • Bejan-Angoulvant, Theodora
  • Saadatian-Elahi, Mitra
  • Lafont, Sandrine
  • Bergeonneau, Claire
  • Kassaï, Behrouz
  • Erpeldinger, Sylvie
  • Wright, James M
  • Gueyffier, François
  • Cornu, Catherine
subjects:
  • 1600
  • Adult
  • Adults
  • Aged
  • Albuminuria - etiology
  • Albuminuria - mortality
  • Blood Glucose - metabolism
  • Cardiovascular diseases
  • Cardiovascular System
  • Cause of Death
  • Clinical trials
  • Clinical Trials (Epidemiology)
  • Congestive heart failure
  • Death
  • Diabetes
  • Diabetes mellitus
  • Diabetes Mellitus, Type 2 - drug therapy
  • Diabetes Mellitus, Type 2 - mortality
  • Diabetic Angiopathies - drug therapy
  • Diabetic Angiopathies - mortality
  • Drugs
  • Epidemiologic Studies
  • Evidence-based medicine
  • Female
  • Glucose
  • Health risk assessment
  • Heart attacks
  • Heart Failure
  • Humans
  • Hypoglycaemia
  • Hypoglycemia
  • Hypoglycemia - chemically induced
  • Hypoglycemic Agents - therapeutic use
  • Internet
  • Ischaemic Heart Disease
  • Life Sciences
  • Male
  • Meta-analysis
  • Metabolic Disorders
  • Microcirculation
  • Microvasculature
  • Middle Aged
  • Mortality
  • Myocardial infarction
  • Myocardial Infarction - mortality
  • Other
  • Proteinurea
  • Quantitative Research
  • Randomized Controlled Trials as Topic
  • Risk Reduction Behavior
  • Statistical analysis
  • Treatment Outcome
  • Type 2 diabetes mellitus
  • Urological Surgery
  • Urology
  • Young Adult
ispartof: BMJ, 2011-07-26, Vol.343 (7817), p.2070-d4169
description: Objective To determine all cause mortality and deaths from cardiovascular events related to intensive glucose lowering treatment in people with type 2 diabetes.Design Meta-analysis of randomised controlled trials.Data sources Medline, Embase, and the Cochrane database of systematic reviews.Study selection Randomised controlled trials that assessed the effect of intensive glucose lowering treatment on cardiovascular events and microvascular complications in adults (≥18 years) with type 2 diabetes.Data extraction Primary end points were all cause mortality and death from cardiovascular causes. Secondary end points were severe hypoglycaemia and macrovascular and microvascular events.Synthesis of results Results are reported as risk ratios with 99% confidence intervals. Statistical heterogeneity between trials was assessed with χ², τ², and I2 statistics. A fixed effect model was used to assess the effect on the outcomes of intensive glucose lowering versus standard treatment. The quality of clinical trials was assessed by the Jadad score.Results 13 studies were included. Of 34 533 patients, 18 315 received intensive glucose lowering treatment and 16 218 standard treatment. Intensive treatment did not significantly affect all cause mortality (risk ratio 1.04, 99% confidence interval 0.91 to 1.19) or cardiovascular death (1.11, 0.86 to 1.43). Intensive therapy was, however, associated with reductions in the risk of non-fatal myocardial infarction (0.85, 0.74 to 0.96, P
language: eng
source:
identifier: ISSN: 0959-8138
fulltext: no_fulltext
issn:
  • 0959-8138
  • 0959-8146
  • 0959-535X
  • 0007-1447
  • 1468-5833
  • 1756-1833
url: Link


@attributes
NO1
SEARCH_ENGINEprimo_central_multiple_fe
SEARCH_ENGINE_TYPEPrimo Central Search Engine
RANK2.7830715
LOCALfalse
PrimoNMBib
record
control
sourceidproquest_pubme
recordidTN_cdi_hal_primary_oai_HAL_hal_00698409v1
sourceformatXML
sourcesystemPC
sourcerecordid1943914913
originalsourceidFETCH-LOGICAL-1672t-2123fabc82d7bb67ea703e380535dff941d69d34f6529d3f8dd65810cee2fb810
addsrcrecordideNqFkt9qFDEUxgdRbKm98AUkqCBCt00mmUzihVBK7SqrIvjnMmQmZ9rUzGRNMqv7ZL6eGbe2tli8GE7I-Z0vXyZfUTwkeJ8Qyg-a_nzfMMLlnWKbMC5mlaD0brGNZSVnglCxVezGeI4xLmktJGf3i62S1JIwWW0XP4-7DtqEfIfskGCIdgXo1I2tj4Cc_w7BDqcoBdCphyFzA9LOoVaPud_7kLSzab2XN4KxfqVjOzodkMn82R7Sg0G9bcNVA1ZZJeazUFovAZXIWN1AgvgC9ZD0TA_araONk6GQx31vIxjU-iEF71xepmC1iw-Ke10usHtRd4pPr44_Hs1ni_cnr48OFzPC6zLNSlLSTjetKE3dNLwGXWMKVOCKVqbrJCOGS0NZx6sy104YwytBcAtQdk1e7BQvN7rLsenBtNl90E4tg-11WCuvrbreGeyZOvUrRQlj-csC842AX8KgbYBrs2aApLxRJa8VxkAEdIZUGlcGDGOsYg01DKDRVdllqecbqbMbDuaHCzXtYcylYFiuJt_PLnwH_22EmFT-kS04pwfwY1QSl1jyuvo_KeQUlZpVmXx8gzz3Y8gPliHBhOCMyAw9uQ0iktFJi9Crq-RsxBigu7wPwWqKtcqxVr9jndlHfz_BJfknxBk4uCHW2qSTnTKjrfun5GwzYWOCH5eKOnxVvKZ1pd59PlIf3nxZnHA2V28z_3TDTxK3O_0F_jkgtA
sourcetypeOpen Access Repository
isCDItrue
recordtypearticle
pqid1943914913
display
typearticle
titleEffect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials
creatorBoussageon, Rémy ; Bejan-Angoulvant, Theodora ; Saadatian-Elahi, Mitra ; Lafont, Sandrine ; Bergeonneau, Claire ; Kassaï, Behrouz ; Erpeldinger, Sylvie ; Wright, James M ; Gueyffier, François ; Cornu, Catherine
creatorcontribBoussageon, Rémy ; Bejan-Angoulvant, Theodora ; Saadatian-Elahi, Mitra ; Lafont, Sandrine ; Bergeonneau, Claire ; Kassaï, Behrouz ; Erpeldinger, Sylvie ; Wright, James M ; Gueyffier, François ; Cornu, Catherine
descriptionObjective To determine all cause mortality and deaths from cardiovascular events related to intensive glucose lowering treatment in people with type 2 diabetes.Design Meta-analysis of randomised controlled trials.Data sources Medline, Embase, and the Cochrane database of systematic reviews.Study selection Randomised controlled trials that assessed the effect of intensive glucose lowering treatment on cardiovascular events and microvascular complications in adults (≥18 years) with type 2 diabetes.Data extraction Primary end points were all cause mortality and death from cardiovascular causes. Secondary end points were severe hypoglycaemia and macrovascular and microvascular events.Synthesis of results Results are reported as risk ratios with 99% confidence intervals. Statistical heterogeneity between trials was assessed with χ², τ², and I2 statistics. A fixed effect model was used to assess the effect on the outcomes of intensive glucose lowering versus standard treatment. The quality of clinical trials was assessed by the Jadad score.Results 13 studies were included. Of 34 533 patients, 18 315 received intensive glucose lowering treatment and 16 218 standard treatment. Intensive treatment did not significantly affect all cause mortality (risk ratio 1.04, 99% confidence interval 0.91 to 1.19) or cardiovascular death (1.11, 0.86 to 1.43). Intensive therapy was, however, associated with reductions in the risk of non-fatal myocardial infarction (0.85, 0.74 to 0.96, P<0.001), and microalbuminuria (0.90, 0.85 to 0.96, P<0.001) but a more than twofold increase in the risk of severe hypoglycaemia (2.33, 21.62 to 3.36, P<0.001). Over a treatment period of five years, 117 to 150 patients would need to be treated to avoid one myocardial infarction and 32 to 142 patients to avoid one episode of microalbuminuria, whereas one severe episode of hypoglycaemia would occur for every 15 to 52 patients. In analysis restricted to high quality studies (Jadad score >3), intensive treatment was not associated with any significant risk of reductions but resulted in a 47% increase in risk of congestive heart failure (P<0.001).Conclusions The overall results of this meta-analysis show limited benefits of intensive glucose lowering treatment on all cause mortality and deaths from cardiovascular causes. We cannot exclude a 9% reduction or a 19% increase in all cause mortality and a 14% reduction or a 43% increase in cardiovascular death. The benefit:risk ratio of intensive glucose lowering treatment in the prevention of macrovascular and microvascular events remains uncertain. The harm associated with severe hypoglycaemia might counterbalance the potential benefit of intensive glucose lowering treatment. More double blind randomised controlled trials are needed to establish the best therapeutic approach in people with type 2 diabetes.
editionInternational edition
identifier
0ISSN: 0959-8138
1ISSN: 0959-8146
2ISSN: 0959-535X
3ISSN: 0007-1447
4EISSN: 1468-5833
5EISSN: 1756-1833
6DOI: 10.1136/bmj.d4169
7PMID: 21791495
8CODEN: BMJOAE
languageeng
publisherEngland: British Medical Journal Publishing Group
subject1600 ; Adult ; Adults ; Aged ; Albuminuria - etiology ; Albuminuria - mortality ; Blood Glucose - metabolism ; Cardiovascular diseases ; Cardiovascular System ; Cause of Death ; Clinical trials ; Clinical Trials (Epidemiology) ; Congestive heart failure ; Death ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - mortality ; Diabetic Angiopathies - drug therapy ; Diabetic Angiopathies - mortality ; Drugs ; Epidemiologic Studies ; Evidence-based medicine ; Female ; Glucose ; Health risk assessment ; Heart attacks ; Heart Failure ; Humans ; Hypoglycaemia ; Hypoglycemia ; Hypoglycemia - chemically induced ; Hypoglycemic Agents - therapeutic use ; Internet ; Ischaemic Heart Disease ; Life Sciences ; Male ; Meta-analysis ; Metabolic Disorders ; Microcirculation ; Microvasculature ; Middle Aged ; Mortality ; Myocardial infarction ; Myocardial Infarction - mortality ; Other ; Proteinurea ; Quantitative Research ; Randomized Controlled Trials as Topic ; Risk Reduction Behavior ; Statistical analysis ; Treatment Outcome ; Type 2 diabetes mellitus ; Urological Surgery ; Urology ; Young Adult
ispartofBMJ, 2011-07-26, Vol.343 (7817), p.2070-d4169
rights
0Boussageon et al 2011
1Copyright: 2011 © Boussageon et al 2011
2Distributed under a Creative Commons Attribution 4.0 International License
3Boussageon et al 2011 2011 Boussageon et al
lds50peer_reviewed
oafree_for_read
citedbyFETCH-LOGICAL-1672t-2123fabc82d7bb67ea703e380535dff941d69d34f6529d3f8dd65810cee2fb810
orcidid0000-0002-9921-0977 ; 0000-0002-9605-8092 ; 0000-0002-1712-120X
links
openurl$$Topenurl_article
thumbnail$$Usyndetics_thumb_exl
backlink
0$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21791495$$D View this record in MEDLINE/PubMed
1$$Uhttps://hal.archives-ouvertes.fr/hal-00698409$$DView record in HAL
search
creatorcontrib
0Boussageon, Rémy
1Bejan-Angoulvant, Theodora
2Saadatian-Elahi, Mitra
3Lafont, Sandrine
4Bergeonneau, Claire
5Kassaï, Behrouz
6Erpeldinger, Sylvie
7Wright, James M
8Gueyffier, François
9Cornu, Catherine
title
0Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials
1BMJ
addtitleBMJ
descriptionObjective To determine all cause mortality and deaths from cardiovascular events related to intensive glucose lowering treatment in people with type 2 diabetes.Design Meta-analysis of randomised controlled trials.Data sources Medline, Embase, and the Cochrane database of systematic reviews.Study selection Randomised controlled trials that assessed the effect of intensive glucose lowering treatment on cardiovascular events and microvascular complications in adults (≥18 years) with type 2 diabetes.Data extraction Primary end points were all cause mortality and death from cardiovascular causes. Secondary end points were severe hypoglycaemia and macrovascular and microvascular events.Synthesis of results Results are reported as risk ratios with 99% confidence intervals. Statistical heterogeneity between trials was assessed with χ², τ², and I2 statistics. A fixed effect model was used to assess the effect on the outcomes of intensive glucose lowering versus standard treatment. The quality of clinical trials was assessed by the Jadad score.Results 13 studies were included. Of 34 533 patients, 18 315 received intensive glucose lowering treatment and 16 218 standard treatment. Intensive treatment did not significantly affect all cause mortality (risk ratio 1.04, 99% confidence interval 0.91 to 1.19) or cardiovascular death (1.11, 0.86 to 1.43). Intensive therapy was, however, associated with reductions in the risk of non-fatal myocardial infarction (0.85, 0.74 to 0.96, P<0.001), and microalbuminuria (0.90, 0.85 to 0.96, P<0.001) but a more than twofold increase in the risk of severe hypoglycaemia (2.33, 21.62 to 3.36, P<0.001). Over a treatment period of five years, 117 to 150 patients would need to be treated to avoid one myocardial infarction and 32 to 142 patients to avoid one episode of microalbuminuria, whereas one severe episode of hypoglycaemia would occur for every 15 to 52 patients. In analysis restricted to high quality studies (Jadad score >3), intensive treatment was not associated with any significant risk of reductions but resulted in a 47% increase in risk of congestive heart failure (P<0.001).Conclusions The overall results of this meta-analysis show limited benefits of intensive glucose lowering treatment on all cause mortality and deaths from cardiovascular causes. We cannot exclude a 9% reduction or a 19% increase in all cause mortality and a 14% reduction or a 43% increase in cardiovascular death. The benefit:risk ratio of intensive glucose lowering treatment in the prevention of macrovascular and microvascular events remains uncertain. The harm associated with severe hypoglycaemia might counterbalance the potential benefit of intensive glucose lowering treatment. More double blind randomised controlled trials are needed to establish the best therapeutic approach in people with type 2 diabetes.
subject
01600
1Adult
2Adults
3Aged
4Albuminuria - etiology
5Albuminuria - mortality
6Blood Glucose - metabolism
7Cardiovascular diseases
8Cardiovascular System
9Cause of Death
10Clinical trials
11Clinical Trials (Epidemiology)
12Congestive heart failure
13Death
14Diabetes
15Diabetes mellitus
16Diabetes Mellitus, Type 2 - drug therapy
17Diabetes Mellitus, Type 2 - mortality
18Diabetic Angiopathies - drug therapy
19Diabetic Angiopathies - mortality
20Drugs
21Epidemiologic Studies
22Evidence-based medicine
23Female
24Glucose
25Health risk assessment
26Heart attacks
27Heart Failure
28Humans
29Hypoglycaemia
30Hypoglycemia
31Hypoglycemia - chemically induced
32Hypoglycemic Agents - therapeutic use
33Internet
34Ischaemic Heart Disease
35Life Sciences
36Male
37Meta-analysis
38Metabolic Disorders
39Microcirculation
40Microvasculature
41Middle Aged
42Mortality
43Myocardial infarction
44Myocardial Infarction - mortality
45Other
46Proteinurea
47Quantitative Research
48Randomized Controlled Trials as Topic
49Risk Reduction Behavior
50Statistical analysis
51Treatment Outcome
52Type 2 diabetes mellitus
53Urological Surgery
54Urology
55Young Adult
issn
00959-8138
10959-8146
20959-535X
30007-1447
41468-5833
51756-1833
fulltextfalse
rsrctypearticle
creationdate2011
recordtypearticle
recordideNqFkt9qFDEUxgdRbKm98AUkqCBCt00mmUzihVBK7SqrIvjnMmQmZ9rUzGRNMqv7ZL6eGbe2tli8GE7I-Z0vXyZfUTwkeJ8Qyg-a_nzfMMLlnWKbMC5mlaD0brGNZSVnglCxVezGeI4xLmktJGf3i62S1JIwWW0XP4-7DtqEfIfskGCIdgXo1I2tj4Cc_w7BDqcoBdCphyFzA9LOoVaPud_7kLSzab2XN4KxfqVjOzodkMn82R7Sg0G9bcNVA1ZZJeazUFovAZXIWN1AgvgC9ZD0TA_araONk6GQx31vIxjU-iEF71xepmC1iw-Ke10usHtRd4pPr44_Hs1ni_cnr48OFzPC6zLNSlLSTjetKE3dNLwGXWMKVOCKVqbrJCOGS0NZx6sy104YwytBcAtQdk1e7BQvN7rLsenBtNl90E4tg-11WCuvrbreGeyZOvUrRQlj-csC842AX8KgbYBrs2aApLxRJa8VxkAEdIZUGlcGDGOsYg01DKDRVdllqecbqbMbDuaHCzXtYcylYFiuJt_PLnwH_22EmFT-kS04pwfwY1QSl1jyuvo_KeQUlZpVmXx8gzz3Y8gPliHBhOCMyAw9uQ0iktFJi9Crq-RsxBigu7wPwWqKtcqxVr9jndlHfz_BJfknxBk4uCHW2qSTnTKjrfun5GwzYWOCH5eKOnxVvKZ1pd59PlIf3nxZnHA2V28z_3TDTxK3O_0F_jkgtA
startdate20110726
enddate20110726
creator
0Boussageon, Rémy
1Bejan-Angoulvant, Theodora
2Saadatian-Elahi, Mitra
3Lafont, Sandrine
4Bergeonneau, Claire
5Kassaï, Behrouz
6Erpeldinger, Sylvie
7Wright, James M
8Gueyffier, François
9Cornu, Catherine
general
0British Medical Journal Publishing Group
1BMJ Publishing Group LTD
2BMJ Publishing Group
3British Medical Association
4BMJ Publishing Group Ltd
scope
09YT
1ACMMV
2BSCLL
3CGR
4CUY
5CVF
6ECM
7EIF
8NPM
9AAYXX
10CITATION
113V.
127RV
137X7
147XB
1588I
168AF
178FE
188FH
198FI
208FJ
218FK
228G5
23ABUWG
24ASE
25AZQEC
26BBNVY
27BENPR
28BHPHI
29BTHHO
30DWQXO
31FPQ
32FYUFA
33GHDGH
34GNUQQ
35GUQSH
36HCIFZ
37K6X
38K9.
39KB0
40LK8
41M2O
42M2P
43M7P
44MBDVC
45NAPCQ
46PADUT
47PQEST
48PQQKQ
49PQUKI
50PRINS
51Q9U
527QJ
537U1
547U2
55C1K
561XC
57BOBZL
58CLFQK
595PM
orcidid
0https://orcid.org/0000-0002-9921-0977
1https://orcid.org/0000-0002-9605-8092
2https://orcid.org/0000-0002-1712-120X
sort
creationdate20110726
titleEffect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials
authorBoussageon, Rémy ; Bejan-Angoulvant, Theodora ; Saadatian-Elahi, Mitra ; Lafont, Sandrine ; Bergeonneau, Claire ; Kassaï, Behrouz ; Erpeldinger, Sylvie ; Wright, James M ; Gueyffier, François ; Cornu, Catherine
facets
frbrtype5
frbrgroupidcdi_FETCH-LOGICAL-1672t-2123fabc82d7bb67ea703e380535dff941d69d34f6529d3f8dd65810cee2fb810
rsrctypearticles
prefilterarticles
languageeng
creationdate2011
topic
01600
1Adult
2Adults
3Aged
4Albuminuria - etiology
5Albuminuria - mortality
6Blood Glucose - metabolism
7Cardiovascular diseases
8Cardiovascular System
9Cause of Death
10Clinical trials
11Clinical Trials (Epidemiology)
12Congestive heart failure
13Death
14Diabetes
15Diabetes mellitus
16Diabetes Mellitus, Type 2 - drug therapy
17Diabetes Mellitus, Type 2 - mortality
18Diabetic Angiopathies - drug therapy
19Diabetic Angiopathies - mortality
20Drugs
21Epidemiologic Studies
22Evidence-based medicine
23Female
24Glucose
25Health risk assessment
26Heart attacks
27Heart Failure
28Humans
29Hypoglycaemia
30Hypoglycemia
31Hypoglycemia - chemically induced
32Hypoglycemic Agents - therapeutic use
33Internet
34Ischaemic Heart Disease
35Life Sciences
36Male
37Meta-analysis
38Metabolic Disorders
39Microcirculation
40Microvasculature
41Middle Aged
42Mortality
43Myocardial infarction
44Myocardial Infarction - mortality
45Other
46Proteinurea
47Quantitative Research
48Randomized Controlled Trials as Topic
49Risk Reduction Behavior
50Statistical analysis
51Treatment Outcome
52Type 2 diabetes mellitus
53Urological Surgery
54Urology
55Young Adult
toplevelpeer_reviewed
creatorcontrib
0Boussageon, Rémy
1Bejan-Angoulvant, Theodora
2Saadatian-Elahi, Mitra
3Lafont, Sandrine
4Bergeonneau, Claire
5Kassaï, Behrouz
6Erpeldinger, Sylvie
7Wright, James M
8Gueyffier, François
9Cornu, Catherine
collection
0BMJ Open Access Journals
1BMJ Journals:Open Access
2Istex
3Medline
4MEDLINE
5MEDLINE (Ovid)
6MEDLINE
7MEDLINE
8PubMed
9CrossRef
10ProQuest Central (Corporate)
11Nursing & Allied Health Database
12Health & Medical Collection
13ProQuest Central (purchase pre-March 2016)
14Science Database (Alumni Edition)
15STEM Database
16ProQuest SciTech Collection
17ProQuest Natural Science Collection
18Hospital Premium Collection
19Hospital Premium Collection (Alumni Edition)
20ProQuest Central (Alumni) (purchase pre-March 2016)
21Research Library (Alumni Edition)
22ProQuest Central (Alumni Edition)
23British Nursing Index
24ProQuest Central Essentials
25Biological Science Collection
26ProQuest Central
27Natural Science Collection
28BMJ Journals
29ProQuest Central Korea
30British Nursing Index (BNI) (1985 to Present)
31Health Research Premium Collection
32Health Research Premium Collection (Alumni)
33ProQuest Central Student
34Research Library Prep
35SciTech Premium Collection
36British Nursing Index
37ProQuest Health & Medical Complete (Alumni)
38Nursing & Allied Health Database (Alumni Edition)
39ProQuest Biological Science Collection
40Research Library
41Science Database
42Biological Science Database
43Research Library (Corporate)
44Nursing & Allied Health Premium
45Research Library China
46ProQuest One Academic Eastern Edition
47ProQuest One Academic
48ProQuest One Academic UKI Edition
49ProQuest Central China
50ProQuest Central Basic
51Applied Social Sciences Index & Abstracts (ASSIA)
52Risk Abstracts
53Safety Science and Risk
54Environmental Sciences and Pollution Management
55Hyper Article en Ligne (HAL)
56OpenAIRE (Open Access)
57OpenAIRE
58PubMed Central (Full Participant titles)
jtitleBMJ
delivery
delcategoryRemote Search Resource
fulltextno_fulltext
addata
au
0Boussageon, Rémy
1Bejan-Angoulvant, Theodora
2Saadatian-Elahi, Mitra
3Lafont, Sandrine
4Bergeonneau, Claire
5Kassaï, Behrouz
6Erpeldinger, Sylvie
7Wright, James M
8Gueyffier, François
9Cornu, Catherine
formatjournal
genrearticle
ristypeJOUR
atitleEffect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials
jtitleBMJ
addtitleBMJ
date2011-07-26
risdate2011
volume343
issue7817
spage
02070
147
2193
3394
42427
51337
6233
7497
82545
91279
102125
111696
122543
132288
14854
151892
16977
17616
18837
19419
202560
21181
22580
23481
241129
251
261765
27266
282215
291720
302457
31103
321047
331463
34129
35405
36307
37b4731
3865
epaged4169
pages2070-d4169
issn
00959-8138
10959-8146
20959-535X
30007-1447
eissn
01468-5833
11756-1833
codenBMJOAE
notesPMCID: PMC3144314
abstractObjective To determine all cause mortality and deaths from cardiovascular events related to intensive glucose lowering treatment in people with type 2 diabetes.Design Meta-analysis of randomised controlled trials.Data sources Medline, Embase, and the Cochrane database of systematic reviews.Study selection Randomised controlled trials that assessed the effect of intensive glucose lowering treatment on cardiovascular events and microvascular complications in adults (≥18 years) with type 2 diabetes.Data extraction Primary end points were all cause mortality and death from cardiovascular causes. Secondary end points were severe hypoglycaemia and macrovascular and microvascular events.Synthesis of results Results are reported as risk ratios with 99% confidence intervals. Statistical heterogeneity between trials was assessed with χ², τ², and I2 statistics. A fixed effect model was used to assess the effect on the outcomes of intensive glucose lowering versus standard treatment. The quality of clinical trials was assessed by the Jadad score.Results 13 studies were included. Of 34 533 patients, 18 315 received intensive glucose lowering treatment and 16 218 standard treatment. Intensive treatment did not significantly affect all cause mortality (risk ratio 1.04, 99% confidence interval 0.91 to 1.19) or cardiovascular death (1.11, 0.86 to 1.43). Intensive therapy was, however, associated with reductions in the risk of non-fatal myocardial infarction (0.85, 0.74 to 0.96, P<0.001), and microalbuminuria (0.90, 0.85 to 0.96, P<0.001) but a more than twofold increase in the risk of severe hypoglycaemia (2.33, 21.62 to 3.36, P<0.001). Over a treatment period of five years, 117 to 150 patients would need to be treated to avoid one myocardial infarction and 32 to 142 patients to avoid one episode of microalbuminuria, whereas one severe episode of hypoglycaemia would occur for every 15 to 52 patients. In analysis restricted to high quality studies (Jadad score >3), intensive treatment was not associated with any significant risk of reductions but resulted in a 47% increase in risk of congestive heart failure (P<0.001).Conclusions The overall results of this meta-analysis show limited benefits of intensive glucose lowering treatment on all cause mortality and deaths from cardiovascular causes. We cannot exclude a 9% reduction or a 19% increase in all cause mortality and a 14% reduction or a 43% increase in cardiovascular death. The benefit:risk ratio of intensive glucose lowering treatment in the prevention of macrovascular and microvascular events remains uncertain. The harm associated with severe hypoglycaemia might counterbalance the potential benefit of intensive glucose lowering treatment. More double blind randomised controlled trials are needed to establish the best therapeutic approach in people with type 2 diabetes.
copEngland
pubBritish Medical Journal Publishing Group
pmid21791495
doi10.1136/bmj.d4169
editionInternational edition
orcidid
0https://orcid.org/0000-0002-9921-0977
1https://orcid.org/0000-0002-9605-8092
2https://orcid.org/0000-0002-1712-120X
oafree_for_read