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

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.

Citation

Aldafas, R., Crabtree, T., Vinogradova, Y., Gordon, J. P., & Idris, I. (2023). Efficacy and safety of intensive versus conventional glucose targets in people with type 2 diabetes: a systematic review and meta-analysis. Expert Review of Endocrinology and Metabolism, 18(1), 95-110. https://doi.org/10.1080/17446651.2023.2166489

• 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
• Publisher: Taylor and Francis
• 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