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Intensive glycemic control and macrovascular, microvascular, hypoglycemia complications and mortality in older (age ≥60years) or frail adults with type 2 diabetes: a systematic review and meta-analysis from randomized controlled trial and observation studies

Crabtree, Thomas; Ogendo, Jael Joy; Vinogradova, Yana; Gordon, Jason; Idris, Iskandar

Intensive glycemic control and macrovascular, microvascular, hypoglycemia complications and mortality in older (age ≥60years) or frail adults with type 2 diabetes: a systematic review and meta-analysis from randomized controlled trial and observation studies Thumbnail


Authors

Thomas Crabtree

Jael Joy Ogendo

Jason Gordon

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



Abstract

Introduction: Guidelines for type 2 diabetes (T2D) recommend individualized HbA1c targets to take into account patient age or frailty. We synthesized evidence from randomized controlled trials and observational studies for intensive glycemic control (HbA1c target ≤58mmol/mol) versus standard care, in elderly (age ≥60years) or frail adults with T2D. Methods: Searches were performed utilizing recognized terms for T2D, frailty, older age, and HbA1c control and outcomes of interest. Meta-analysis was performed where possible. Primary outcomes included all-cause mortality, severe hypoglycemia, and hospital admission rates. Vascular complications, cognitive decline, and falls/fractures were secondary outcomes. Results: 7,528 studies were identified of which 15 different clinical studies were selected. No difference was noted in all-cause mortality with intensive control (pooled hazard ratio 0.96, 95% confidence interval 0.90–1.03), but risk of severe hypoglycemia increased (2.45, 2.22–2.72). Intensive control was associated reductions in microvascular (0.73, 0.68–0.79) and macrovascular complications (0.84, 0.79–0.89). Outcome data for risk of hospitalization, cognition, and falls/fractures were limited. Conclusion: Intensive glycemic control was associated with reduced rates of complications but increased severe hypoglycemia. Significant heterogeneity exists and the impact of different drug regimens is unclear. Caution is needed when setting glycemic targets in elderly or frail individuals.

Citation

Crabtree, T., Ogendo, J. J., Vinogradova, Y., Gordon, J., & Idris, I. (2022). Intensive glycemic control and macrovascular, microvascular, hypoglycemia complications and mortality in older (age ≥60years) or frail adults with type 2 diabetes: a systematic review and meta-analysis from randomized controlled trial and observation studies. Expert Review of Endocrinology and Metabolism, https://doi.org/10.1080/17446651.2022.2079495

Journal Article Type Article
Acceptance Date May 16, 2022
Online Publication Date May 25, 2022
Publication Date May 25, 2022
Deposit Date May 27, 2022
Publicly Available Date Mar 29, 2024
Journal Expert Review of Endocrinology & Metabolism
Print ISSN 1744-6651
Electronic ISSN 1744-8417
Publisher Informa UK Limited
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1080/17446651.2022.2079495
Keywords Endocrinology, Diabetes and Metabolism
Public URL https://nottingham-repository.worktribe.com/output/8225729
Publisher URL https://www.tandfonline.com/doi/abs/10.1080/17446651.2022.2079495?src=&journalCode=iere20
Additional Information This is an Accepted Manuscript of an article published by Taylor & Francis in Expert Review of Endocrinology and Metabolism on 25/05/2022, available at: https://www.tandfonline.com/doi/abs/10.1080/17446651.2022.2079495?src=&journalCode=iere20

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