Comment: The quality of evidence is downgraded by inconsistency (unexplained variability in results).
Clinical comment: In prevention of diabetic complications good glycaemic control, treatment of hypertension and dyslipidaemia, and lifestyle interventions are all important.
A Cochrane review included 11 studies with a total of 29 141 subjects. Treatment duration was 56.7 months on average (range 6 months to 10 years). Studies included people with a range of kidney function. Tight glycaemic control (HbA1c under 7%) compared with standard control made little or no difference to doubling of serum creatinine (SCr), all-cause mortality, cardiovascular mortality, or sudden death . Onset and progression of microalbuminuria was decreased in tight glycaemic control group . There was a trend towards decreased end-stage kidney disease (ESKD) and risk of non-fatal myocardial infarction.
| Outcome (follow up) | Relative effect (95% CI) | Assumed risk - Control- Non-tight control | Corresponding risk - Intervention - Tight control (95% CI) | No. of participants (studies) Confidence of evidence |
|---|---|---|---|---|
| Doubling serum creatinine (8.3 years) | RR 0.84 (0.64 to 1.11) | 39 per 1000 | 33 per 1000 (25 to 43.3) | 26 874 (4) Low |
| End-stage kidney disease (5.9 years) | RR 0.62 (0.34 to 1.12) | 3 per 1000 | 2 per 1000 (1.0 to 3.4) | 23 332 (4) Low |
| Onset microalbuminuria (5.4 years) | RR 0.85 (0.77 to 0.94) | 46 per 1000 | 39 per 1000 (35.4 to 43.2) | 19 933 (4) Moderate |
| Progression of microalbuminuria (5.8 years) | RR 0.59 (0.38 to 0.93) | 4 per 1000 | 2 per 1000 (1.5 to 3.7) | 13 266 (5) Moderate |
| Cardiovascular mortality (4.4 years) | RR 1.19 (0.73 to 1.92) | 9 per 1000 | 11 per 1000 (6.6 to 17.3) | 23 673 (6) Low |
| All-cause mortality (5.6 years) | RR 0.99 (0.86 to 1.13) | 16 per 1000 | 16 per 1000 (13.8 to 18.1) | 29 094 (9) Moderate |
| Non-fatal myocardial infarction (5.6 years) | RR 0.82 (0.67 to 0.99) | 8 per 1000 | 7 per 1000 (5.4 to 7.9) | 25 596 (5) Moderate |
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