Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus

There appears to be no difference for all-cause mortality and cardiovascular mortality when targeting intensive glycaemic control compared with conventional glycaemic control in patients with type 2 diabetes. Targeting intensive glycaemic control may reduce the risk of microvascular complications, but it increases the risk of hypoglycaemia and might possibly increase total mortality in a population of patients with high prevalence of cardiovascular disease.

Summary

A Cochrane review [withdrawn from publication] included 20 studies with a total of 29 986 subjects to compare the effects of intensive versus conventional glycaemic control on cardiovascular morbidity and mortality in patients with type 2 diabetes (T2D).

Definition of intensive glycaemic control varied between trials (glycosylated haemoglobin of < 6.0% to <7.0% or fasting plasma glucose below 6.0mmol/l). Dietary interventions, per oral glucose lowering medications and/or insulin therapy were used in the trials. The comparison of main outcomes with number of participants, duration of follow-up and estimates of risk for each comparison is given in Table 1.

Clinical comments

The studies did not make a difference between patients with recently diagnosed DM2 and those with long-term disease and comorbidity. As long as the treatment consists of metformin and lifestyle interventions, aiming at strict targets is not likely to cause harm. In more advanced disease and particularly in patients with cardiovascular disease, targeting at intensive glycaemic control may be associated with increased total mortality.

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Ədəbiyyat

1. Hemmingsen B, Lund SS, Gluud C et al. WITHDRAWN: Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cochrane Database Syst Rev 2015;(7):CD008143.