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22-07-2009 | Diabetes | Article

Intensive glucose control reduces CVD, but increases severe hypoglycemia risk

Abstract

Free abstract

MedWire News: Results from a meta-analysis show that intensive glucose control reduces the risk for cardiovascular disease (CVD) in individuals with Type 2 diabetes to a greater extent than conventional control.

However, the risk for severe hypoglycemia in the intensively treated group was significantly higher than for those treated conventionally.

“Clinical trials have shown that intensive glucose control reduces the risk for microvascular complications among patients with Type 2 diabetes, but its effect on CVD, including coronary heart disease (CHD), stroke, and peripheral arterial disease, is uncertain,” say Tanika Kelly (Tulane University School of Public Health and Tropical Medicine, New Orleans, Los Angeles, USA) and colleagues.

The team selected five suitable trials with a total of 27,802 participants aged between 53 and 66 years.

Inclusion criteria for the studies used in the analysis were being a randomized controlled trial, comparing intensive (glycated hemoglobin [HbA1c] target of below 6.5%) with conventional treatment (usually HbA1c target of 7–9%) for Type 2 diabetes, having clinical CVD as a primary endpoint, and including 500 participants or more. Study duration ranged from 3.4 to 10.7 years.

The researchers found that, compared with conventional control, intensive glucose control significantly reduced the relative risk for CVD by 30%, but did not reduce the risk for cardiovascular death or all-cause mortality.

In contrast, the relative risk for severe hypoglycemia was 2.03-fold higher in the intensive versus the conventional therapy group.

“The results of this meta-analysis provide some evidence for a beneficial effect of intensive glucose control on CVD, particularly on nonfatal myocardial infarction, but not on cardiovascular deaths and all-cause mortality in patients with Type 2 diabetes,” conclude Kelly et al in the Annals of Internal Medicine.

“Furthermore, our results emphasize severe hypoglycemia as an important adverse effect of intensive glucose control.”

They suggest that “health care providers should focus their efforts on combining elements of lifestyle modification, glucose control that minimizes hypoglycemia, blood pressure reduction, and lipid lowering to optimally curtail the risk for CVD in patients with Type 2 diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Helen Albert