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Efficacy and safety of intensive versus conventional glucose targets in people with type 2 diabetes: a systematic review and meta-analysis

Aldafas, Rami; Crabtree, Thomas; Vinogradova, Yana; Gordon, Jason P; Idris, Iskandar

Efficacy and safety of intensive versus conventional glucose targets in people with type 2 diabetes: a systematic review and meta-analysis Thumbnail


Authors

Rami Aldafas

Thomas Crabtree

Jason P Gordon

ISKANDAR IDRIS Iskandar.Idris@nottingham.ac.uk
Professor of Diabetes and Metabolic Medicine



Abstract

Objective: The aim of study is to re-evaluate the risk-benefits of intensive glycemic control in the context of multi-factorial intervention in adults with T2D.

Methods: We searched Ovid MEDLINE, Embase, Cochrane, and CINHAL for randomized control trials comparing standard glucose targets to intensive glucose targets with pre-specified HbA1clevels. Subgroup analysis was also performed to account for the inclusion of glucose only versus multi-factorial intervention trials. Results are reported as risk ratio (RR) and 95% confidence interval (CI).

Results: Fifty-seven publications including 19 trials were included. Compared to conventional glycemic control, intensive glycemic control decreased the risk of non-fatal myocardial infarction (0.8, 0.7-0.91), macroalbuminuria (0.72, 0.5­–0.87), microalbuminuria (0.67, 0.52–0.85), major amputation (0.6, 0.38–0.96), retinopathy (0.75,0.63–0.9), and nephropathy (0.78, 0.63–0.97). The risk of hypoglycemia increased with intensive glycemic control than conventional treatment (2.04, 1.34–3.1). No reduction in all-cause or cardiovascular mortality was observed. However, in the context of multifactorial intervention, intensive glucose control was associated with a significant reduction in all-cause mortality (0.74, 0.57–0.95).

Conclusion: Targeting HbA1c levels should be individualized based on the clinical status, balancing risks and benefits and potential risk for developing these complications among people with T2D.

Journal Article Type Review
Acceptance Date Jan 5, 2023
Online Publication Date Jan 31, 2023
Publication Date 2023
Deposit Date Jan 19, 2023
Publicly Available Date Feb 1, 2024
Journal Expert Review of Endocrinology and Metabolism
Print ISSN 1744-6651
Electronic ISSN 1744-8417
Peer Reviewed Peer Reviewed
Volume 18
Issue 1
Pages 95-110
DOI https://doi.org/10.1080/17446651.2023.2166489
Public URL https://nottingham-repository.worktribe.com/output/16225943
Publisher URL https://www.tandfonline.com/doi/full/10.1080/17446651.2023.2166489
Additional Information This is an Accepted Manuscript of an article published by Taylor & Francis in Expert Review & endocrinology & Metabolism on3 1 Jan 2023, available at: https://www.tandfonline.com/0.1080/17446651.2023.2166489