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Intensive glucose control reduces coronary events in type 2 diabetes
Although trials of intensive glucose control in type 2 diabetes have demonstrated clear reductions in microvascular outcomes, they have not shown consistent beneficial effects on cardiovascular events. Ray et al performed a meta-analysis of five randomised controlled trials of glucose control to determine if intensive glucose treatment influenced macrovascular events and all-cause mortality compared with standard treatment.
Data from 33 040 patients were analysed, and the five trials provided information on 1497 events of non-fatal myocardial infarction, 2318 coronary heart disease events, 1127 strokes and 2892 cases of all-cause mortality over approximately 163 000 person-years of follow-up. Those given intensive treatment had a mean HbA1c concentration that was 0.9% lower than for those given standard treatment. A 17% reduction in events of non-fatal myocardial infarction (OR = 0.83; 95% CI 0.75 to 0.93), and a 15% reduction in events of coronary heart disease (OR = 0.85; 95% CI 0.77 to 0.93) was seen in patients receiving intensive glycaemic control. However, no significant difference was seen in the number of stroke events, nor in all-cause mortality.
These results suggest that an intensive glucose control regimen can reduce coronary events in patients with type 2 diabetes, and support the current ACC and AHA recommendation that doctors should aim to lower HbA1c to a target of 7.0% or lower in these patients.
Ray KK, Seshasai SR, Wijesuriya S, . Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet 2009;373:1765–72.
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