Does More Intensive Glucose Control Benefit Patients With Diabetes?

Adults with type 2 diabetes benefit from more intensive glucose control, researchers reported in a recent study.

Previous research has demonstrated that intensive glucose control can prevent complications of diabetes, but investigators wanted to better understand the specific effects of more intensive verus less intensive glucose control on microvascular events.

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In a meta-analysis, researchers used anonymized data from randomized controlled trials that evaluated the impact of more intensive glucose control compared with less intensive glucose control in adult patients with type 2 diabetes. The large-scale trials (ACCORD, ADVANCE, UKPDS, and VADT) included 27,049 participants and had at least 1,000 years of follow-up in each treatment group and a minimum 2 years average follow-up on randomized treatment.

During the follow-up period, which was a median of 5 years, there were 1,626 kidney events, 795 eye events, and 7,598 nerve events. When more intensive and less intensive glucose control were compared, results showed a relative risk reduction of 20% for kidney events (hazard ratio, 0.80; 95% confidence interval, 0.72 to 0.88) and 13% for eye events (hazard ratio, 0.87; 95% confidence interval, 0.76 to 1.00). There was no reduction in relative risk for nerve events.

The data also revealed that more intensive glucose control led to an absolute difference of −0·90% (95% confidence interval, −1.22 to −0.58) in mean HbA1c when follow-up was completed.

“More intensive glucose control over 5 years reduced both kidney and eye events. Glucose lowering remains important for the prevention of long-term microvascular complications in adults with type 2 diabetes,” the study’s authors concluded.

—Lauren LeBano

Reference

Zougas S, Arima H, Gerstein HC, et al. Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes: a meta-analysis of individual participant data from randomised controlled trials. Lancet. 2017;5(6):431-437.