期刊
ANNALS OF MEDICINE
卷 42, 期 4, 页码 305-315出版社
TAYLOR & FRANCIS LTD
DOI: 10.3109/07853891003796752
关键词
Cardiovascular events; intensive glucose control; meta-analysis; randomized controlled trials; type 2 diabetes
资金
- National Basic Research Program of China [2006CB503803, 2005CB523302]
- 863 Program of Science and Technology Ministry [2006AA0ZA406]
- National Natural Science Foundation of China [30725036]
- Key Projects in the National Science & Technology Pillar Program in the Eleventh Five-year Plan Period [2006BAI01A04]
Background. The effects of intensive glucose control over conventional glucose control on cardiovascular outcomes of patients with type 2 diabetes remain uncertain. Methods. We searched MEDLINE, EMBASE, and the Cochrane database to identify randomized controlled trials that compared the effects of intensive glucose control and conventional glucose control, on cardiovascular events in patients with type 2 diabetes. Results. Seven trials involving 34,144 participants with type 2 diabetes were included. Intensive glucose control significantly reduced major cardiovascular events by 10% (relative risk (RR) 0.90, 95% CI 0.85-0.96; P - 0.0006), and non-fatal myocardial infarction by 16% (0.84, 95% CI 0.76-0.93; P = 0.0006) at the expense of increased incidence of severe hypoglycemia (2.30, 95% CI 1.74-3.03; P < 0.00001), while all-cause mortality, cardiovascular death, non-fatal stroke, and heart failure were similar between the two groups. Subgroup analyses showed that patients with longer follow-up duration, shorter diabetic duration, less glycosylated hemoglobin (HbA1c) reduction, higher HbA1c concentration at follow-up, and lower base-line HbA1c benefited more from intensive glucose control. Conclusion. An intensive glucose control strategy can effectively reduce the risk of major cardiovascular events but at the expense of a significantly increased risk of severe hypoglycemia in patients with type 2 diabetes.
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