The effect of intensive glucose control on all-cause and cardiovascular mortality, myocardial infarction and stroke in persons with type 2 diabetes mellitus: A systematic review and meta-analysis

Steven P. Marso, Kevin F. Kennedy, John A. House, Darren K. McGuire

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37 Citations (Scopus)

Abstract

We performed a meta-analysis of studies evaluating the effect of intensive glucose control on major adverse cardiovascular events in patients with type 2 diabetes from 1990 to 2009. A search of the published literature and the Cochran Central Register for Controlled Trials was performed using pre-specified inclusion criteria consisting of randomised controlled trials evaluating intensive glycaemic control and reporting the individual endpoints of all-cause mortality, nonfatal myocardial infarction, and non-fatal stroke. Incident rate ratios for these endpoints were calculated using standard meta-analytic techniques of pooled data from eligible trials. Six reports from four randomised trials including 27,544 patients met the pre-specified inclusion criteria. Mean follow-up was 5.4 years; haemoglobin AIC at study end was 6.6% vs. 7.4% in patients randomised to intensive compared with conventional glucose control. Intensive glucose control did not affect the incident rate ratio for all-cause mortality (1.01, 95% confidence interval 0.86-1.18, p=0.54) or stroke (1.02, 95% confidence interval 0.88-1.20, p=0.62). However, there was a statistically significant 14% reduction in nonfatal myocardial infarction in patients randomised to intensive glucose control (0.86, 95% confidence interval 0.77-0.97, p=0.0I5). Although intensification of glucose control did not affect mortality or non-fatal stroke, the risk for non-fatal myocardial infarction was significantly reduced in patients with type 2 diabetes.

Original languageEnglish (US)
Pages (from-to)119-130
Number of pages12
JournalDiabetes and Vascular Disease Research
Volume7
Issue number2
DOIs
StatePublished - Apr 2010

Fingerprint

Type 2 Diabetes Mellitus
Meta-Analysis
Stroke
Myocardial Infarction
Glucose
Mortality
Confidence Intervals
Hemoglobins
Randomized Controlled Trials

Keywords

  • Diabetes mellitus
  • Glucose lowering
  • MACE
  • Macrovascular complications
  • Mortality
  • Myocardial infarction
  • Stroke

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

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title = "The effect of intensive glucose control on all-cause and cardiovascular mortality, myocardial infarction and stroke in persons with type 2 diabetes mellitus: A systematic review and meta-analysis",
abstract = "We performed a meta-analysis of studies evaluating the effect of intensive glucose control on major adverse cardiovascular events in patients with type 2 diabetes from 1990 to 2009. A search of the published literature and the Cochran Central Register for Controlled Trials was performed using pre-specified inclusion criteria consisting of randomised controlled trials evaluating intensive glycaemic control and reporting the individual endpoints of all-cause mortality, nonfatal myocardial infarction, and non-fatal stroke. Incident rate ratios for these endpoints were calculated using standard meta-analytic techniques of pooled data from eligible trials. Six reports from four randomised trials including 27,544 patients met the pre-specified inclusion criteria. Mean follow-up was 5.4 years; haemoglobin AIC at study end was 6.6{\%} vs. 7.4{\%} in patients randomised to intensive compared with conventional glucose control. Intensive glucose control did not affect the incident rate ratio for all-cause mortality (1.01, 95{\%} confidence interval 0.86-1.18, p=0.54) or stroke (1.02, 95{\%} confidence interval 0.88-1.20, p=0.62). However, there was a statistically significant 14{\%} reduction in nonfatal myocardial infarction in patients randomised to intensive glucose control (0.86, 95{\%} confidence interval 0.77-0.97, p=0.0I5). Although intensification of glucose control did not affect mortality or non-fatal stroke, the risk for non-fatal myocardial infarction was significantly reduced in patients with type 2 diabetes.",
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