Efficacy and safety of intensive versus conventional glucose targets in people with type 2 diabetes: a systematic review and meta-analysis.

IF 2.7 Q3 ENDOCRINOLOGY & METABOLISM Expert Review of Endocrinology & Metabolism Pub Date : 2023-01-01 DOI:10.1080/17446651.2023.2166489

Rami Aldafas, Thomas Crabtree, Yana Vinogradova, Jason P Gordon, Iskandar Idris

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Abstract

Objective: The aim of study is to re-evaluate the risk-benefits of intensive glycemic control in the context of multi-factorial intervention in adults with T2D.

Methods: We searched Ovid MEDLINE, Embase, Cochrane, and CINHAL for randomized control trials comparing standard glucose targets to intensive glucose targets with pre-specified HbA_1clevels. Subgroup analysis was also performed to account for the inclusion of glucose only versus multi-factorial intervention trials. Results are reported as risk ratio (RR) and 95% confidence interval (CI).

Results: Fifty-seven publications including 19 trials were included. Compared to conventional glycemic control, intensive glycemic control decreased the risk of non-fatal myocardial infarction (0.8, 0.7-0.91), macroalbuminuria (0.72, 0.5--0.87), microalbuminuria (0.67, 0.52-0.85), major amputation (0.6, 0.38-0.96), retinopathy (0.75 ,0.63-0.9), and nephropathy (0.78, 0.63-0.97). The risk of hypoglycemia increased with intensive glycemic control than conventional treatment (2.04, 1.34-3.1). No reduction in all-cause or cardiovascular mortality was observed. However, in the context of multifactorial intervention, intensive glucose control was associated with a significant reduction in all-cause mortality (0.74, 0.57-0.95).

Conclusion: Targeting HbA_1c levels should be individualized based on the clinical status, balancing risks and benefits and potential risk for developing these complications among people with T2D.

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2型糖尿病患者强化降糖与常规降糖的疗效和安全性:一项系统综述和荟萃分析

目的:本研究的目的是重新评估在多因素干预下强化血糖控制对成人T2D患者的风险-收益。方法:我们检索了Ovid MEDLINE、Embase、Cochrane和CINHAL的随机对照试验，比较标准血糖指标和预先指定hba1水平的强化血糖指标。还进行了亚组分析，以解释仅葡萄糖与多因素干预试验的差异。结果以风险比(RR)和95%置信区间(CI)报告。结果:纳入文献57篇，包括19项试验。与常规血糖控制相比，强化血糖控制降低了非致死性心肌梗死(0.8,0.7-0.91)、大量蛋白尿(0.72,0.5- 0.87)、微量蛋白尿(0.67,0.52-0.85)、严重截肢(0.6,0.38-0.96)、视网膜病变(0.75,0.63-0.9)和肾病(0.78,0.63-0.97)的风险。与常规治疗相比，强化血糖控制会增加低血糖的风险(2.04,1.34-3.1)。未观察到全因死亡率或心血管死亡率降低。然而，在多因素干预的情况下，强化血糖控制与全因死亡率的显著降低相关(0.74,0.57-0.95)。结论:针对HbA1c水平应根据临床状况进行个体化调整，平衡T2D患者发生这些并发症的风险和获益。

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来源期刊

Expert Review of Endocrinology & Metabolism ENDOCRINOLOGY & METABOLISM-

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4.80

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0.00%

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期刊介绍： Implicated in a plethora of regulatory dysfunctions involving growth and development, metabolism, electrolyte balances and reproduction, endocrine disruption is one of the highest priority research topics in the world. As a result, we are now in a position to better detect, characterize and overcome the damage mediated by adverse interaction with the endocrine system. Expert Review of Endocrinology and Metabolism (ISSN 1744-6651), provides extensive coverage of state-of-the-art research and clinical advancements in the field of endocrine control and metabolism, with a focus on screening, prevention, diagnostics, existing and novel therapeutics, as well as related molecular genetics, pathophysiology and epidemiology.