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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... Full description

Journal Title: The Lancet (British edition) 2009, Vol.373 (9677), p.1765-1772
Main Author: Ray, Kausik K, Dr
Other Authors: Seshasai, Sreenivasa Rao Kondapally, MD , Wijesuriya, Shanelle, BA , Sivakumaran, Rupa, BA , Nethercott, Sarah, BA , Preiss, David, MRCP , Erqou, Sebhat, MD , Sattar, Naveed, Prof
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials
format: Article
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
subjects:
  • Abridged Index Medicus
  • Antilipemic agents
  • Biological and medical sciences
  • Blood Glucose - metabolism
  • Blood sugar
  • Cardiovascular disease
  • Cardiovascular Diseases - epidemiology
  • Cardiovascular Diseases - etiology
  • Cardiovascular Diseases - prevention & control
  • Care and treatment
  • 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
  • Dosage and administration
  • Endocrine pancreas. Apud cells (diseases)
  • Endocrinopathies
  • Etiopathogenesis. Screening. Investigations. Target tissue resistance
  • Female
  • General aspects
  • Glucose
  • Glycated Hemoglobin A - metabolism
  • Heart attacks
  • Humans
  • Internal Medicine
  • Male
  • Medical sciences
  • Middle Aged
  • Mortality
  • Multicenter Studies as Topic
  • Odds Ratio
  • Patient outcomes
  • Patients
  • Physiological aspects
  • Proportional Hazards Models
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Research Design
  • Risk Factors
  • Risk Reduction Behavior
  • Sensitivity and Specificity
  • Systematic review
  • Treatment Outcome
  • Type 2 diabetes
ispartof: The Lancet (British edition), 2009, Vol.373 (9677), p.1765-1772
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.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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titleEffect 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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creatorRay, 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
creatorcontribRay, 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
descriptionSummary 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.
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languageeng
publisherKidlington: Elsevier Ltd
subjectAbridged Index Medicus ; Antilipemic agents ; Biological and medical sciences ; Blood Glucose - metabolism ; Blood sugar ; Cardiovascular disease ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - prevention & control ; Care and treatment ; 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 ; Dosage and administration ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; General aspects ; Glucose ; Glycated Hemoglobin A - metabolism ; Heart attacks ; Humans ; Internal Medicine ; Male ; Medical sciences ; Middle Aged ; Mortality ; Multicenter Studies as Topic ; Odds Ratio ; Patient outcomes ; Patients ; Physiological aspects ; Proportional Hazards Models ; Prospective Studies ; Randomized Controlled Trials as Topic ; Research Design ; Risk Factors ; Risk Reduction Behavior ; Sensitivity and Specificity ; Systematic review ; Treatment Outcome ; Type 2 diabetes
ispartofThe Lancet (British edition), 2009, Vol.373 (9677), p.1765-1772
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descriptionSummary 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.
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0Abridged Index Medicus
1Antilipemic agents
2Biological and medical sciences
3Blood Glucose - metabolism
4Blood sugar
5Cardiovascular disease
6Cardiovascular Diseases - epidemiology
7Cardiovascular Diseases - etiology
8Cardiovascular Diseases - prevention & control
9Care and treatment
10Cause of Death
11Clinical outcomes
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13Deaths
14Diabetes
15Diabetes Mellitus, Type 2 - blood
16Diabetes Mellitus, Type 2 - complications
17Diabetes Mellitus, Type 2 - mortality
18Diabetes Mellitus, Type 2 - prevention & control
19Diabetes. Impaired glucose tolerance
20Dosage and administration
21Endocrine pancreas. Apud cells (diseases)
22Endocrinopathies
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45Risk Reduction Behavior
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titleEffect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials
authorRay, 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
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1Antilipemic agents
2Biological and medical sciences
3Blood Glucose - metabolism
4Blood sugar
5Cardiovascular disease
6Cardiovascular Diseases - epidemiology
7Cardiovascular Diseases - etiology
8Cardiovascular Diseases - prevention & control
9Care and treatment
10Cause of Death
11Clinical outcomes
12Clinical trials
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14Diabetes
15Diabetes Mellitus, Type 2 - blood
16Diabetes Mellitus, Type 2 - complications
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41Prospective Studies
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44Risk Factors
45Risk Reduction Behavior
46Sensitivity and Specificity
47Systematic review
48Treatment Outcome
49Type 2 diabetes
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abstractSummary 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.
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pubElsevier Ltd
pmid19465231
doi10.1016/S0140-6736(09)60697-8