Intensive glucose control and macrovascular outcomes in type 2 diabetes

F. M. Turnbull, C. Abraira, Robert J. Anderson, R. P. Byington, J. P. Chalmers, W. C. Duckworth, G. W. Evans, H. C. Gerstein, R. R. Holman, T. E. Moritz, B. C. Neal, T. Ninomiya, A. A. Patel, S. K. Paul, F. Travert, M. Woodward

Research output: Contribution to journalArticle

728 Citations (Scopus)

Abstract

Aims/hypothesis: Improved glucose control in type 2 diabetes is known to reduce the risk of microvascular events. There is, however, continuing uncertainty about its impact on macrovascular disease. The aim of these analyses was to generate more precise estimates of the effects of more-intensive, compared with less-intensive, glucose control on the risk of major cardiovascular events amongst patients with type 2 diabetes. Methods: A prospectively planned group-level meta-analysis in which characteristics of trials to be included, outcomes of interest, analyses and subgroup definitions were all pre-specified. Results: A total of 27,049 participants and 2,370 major vascular events contributed to the meta-analyses. Allocation to more-intensive, compared with less-intensive, glucose control reduced the risk of major cardiovascular events by 9% (HR 0.91, 95% CI 0.84-0.99), primarily because of a 15% reduced risk of myocardial infarction (HR 0.85, 95% CI 0.76-0.94). Mortality was not decreased, with non-significant HRs of 1.04 for all-cause mortality (95% CI 0.90-1.20) and 1.10 for cardiovascular death (95% CI 0.84-1.42). Intensively treated participants had significantly more major hypoglycaemic events (HR 2.48, 95% CI 1.91-3.21). Exploratory subgroup analyses suggested the possibility of a differential effect for major cardiovascular events in participants with and without macrovascular disease (HR 1.00, 95% CI 0.89-1.13, vs HR 0.84, 95% CI 0.74-0.94, respectively; interaction p=0.04). Conclusions/interpretation: Targeting more-intensive glucose lowering modestly reduced major macrovascular events and increased major hypoglycaemia over 4.4 years in persons with type 2 diabetes. The analyses suggest that glucose-lowering regimens should be tailored to the individual.

Original languageEnglish
Pages (from-to)2288-2298
Number of pages11
JournalDiabetologia
Volume52
Issue number11
DOIs
StatePublished - Nov 2009
Externally publishedYes

Fingerprint

Type 2 Diabetes Mellitus
Glucose
Meta-Analysis
Mortality
Hypoglycemia
Hypoglycemic Agents
Uncertainty
Blood Vessels
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Turnbull, F. M., Abraira, C., Anderson, R. J., Byington, R. P., Chalmers, J. P., Duckworth, W. C., ... Woodward, M. (2009). Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia, 52(11), 2288-2298. https://doi.org/10.1007/s00125-009-1470-0

Intensive glucose control and macrovascular outcomes in type 2 diabetes. / Turnbull, F. M.; Abraira, C.; Anderson, Robert J.; Byington, R. P.; Chalmers, J. P.; Duckworth, W. C.; Evans, G. W.; Gerstein, H. C.; Holman, R. R.; Moritz, T. E.; Neal, B. C.; Ninomiya, T.; Patel, A. A.; Paul, S. K.; Travert, F.; Woodward, M.

In: Diabetologia, Vol. 52, No. 11, 11.2009, p. 2288-2298.

Research output: Contribution to journalArticle

Turnbull, FM, Abraira, C, Anderson, RJ, Byington, RP, Chalmers, JP, Duckworth, WC, Evans, GW, Gerstein, HC, Holman, RR, Moritz, TE, Neal, BC, Ninomiya, T, Patel, AA, Paul, SK, Travert, F & Woodward, M 2009, 'Intensive glucose control and macrovascular outcomes in type 2 diabetes', Diabetologia, vol. 52, no. 11, pp. 2288-2298. https://doi.org/10.1007/s00125-009-1470-0
Turnbull FM, Abraira C, Anderson RJ, Byington RP, Chalmers JP, Duckworth WC et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. 2009 Nov;52(11):2288-2298. https://doi.org/10.1007/s00125-009-1470-0
Turnbull, F. M. ; Abraira, C. ; Anderson, Robert J. ; Byington, R. P. ; Chalmers, J. P. ; Duckworth, W. C. ; Evans, G. W. ; Gerstein, H. C. ; Holman, R. R. ; Moritz, T. E. ; Neal, B. C. ; Ninomiya, T. ; Patel, A. A. ; Paul, S. K. ; Travert, F. ; Woodward, M. / Intensive glucose control and macrovascular outcomes in type 2 diabetes. In: Diabetologia. 2009 ; Vol. 52, No. 11. pp. 2288-2298.
@article{ebf67842d3ae4053933a338851debc1e,
title = "Intensive glucose control and macrovascular outcomes in type 2 diabetes",
abstract = "Aims/hypothesis: Improved glucose control in type 2 diabetes is known to reduce the risk of microvascular events. There is, however, continuing uncertainty about its impact on macrovascular disease. The aim of these analyses was to generate more precise estimates of the effects of more-intensive, compared with less-intensive, glucose control on the risk of major cardiovascular events amongst patients with type 2 diabetes. Methods: A prospectively planned group-level meta-analysis in which characteristics of trials to be included, outcomes of interest, analyses and subgroup definitions were all pre-specified. Results: A total of 27,049 participants and 2,370 major vascular events contributed to the meta-analyses. Allocation to more-intensive, compared with less-intensive, glucose control reduced the risk of major cardiovascular events by 9{\%} (HR 0.91, 95{\%} CI 0.84-0.99), primarily because of a 15{\%} reduced risk of myocardial infarction (HR 0.85, 95{\%} CI 0.76-0.94). Mortality was not decreased, with non-significant HRs of 1.04 for all-cause mortality (95{\%} CI 0.90-1.20) and 1.10 for cardiovascular death (95{\%} CI 0.84-1.42). Intensively treated participants had significantly more major hypoglycaemic events (HR 2.48, 95{\%} CI 1.91-3.21). Exploratory subgroup analyses suggested the possibility of a differential effect for major cardiovascular events in participants with and without macrovascular disease (HR 1.00, 95{\%} CI 0.89-1.13, vs HR 0.84, 95{\%} CI 0.74-0.94, respectively; interaction p=0.04). Conclusions/interpretation: Targeting more-intensive glucose lowering modestly reduced major macrovascular events and increased major hypoglycaemia over 4.4 years in persons with type 2 diabetes. The analyses suggest that glucose-lowering regimens should be tailored to the individual.",
author = "Turnbull, {F. M.} and C. Abraira and Anderson, {Robert J.} and Byington, {R. P.} and Chalmers, {J. P.} and Duckworth, {W. C.} and Evans, {G. W.} and Gerstein, {H. C.} and Holman, {R. R.} and Moritz, {T. E.} and Neal, {B. C.} and T. Ninomiya and Patel, {A. A.} and Paul, {S. K.} and F. Travert and M. Woodward",
year = "2009",
month = "11",
doi = "10.1007/s00125-009-1470-0",
language = "English",
volume = "52",
pages = "2288--2298",
journal = "Diabetologia",
issn = "0012-186X",
publisher = "Springer Verlag",
number = "11",

}

TY - JOUR

T1 - Intensive glucose control and macrovascular outcomes in type 2 diabetes

AU - Turnbull, F. M.

AU - Abraira, C.

AU - Anderson, Robert J.

AU - Byington, R. P.

AU - Chalmers, J. P.

AU - Duckworth, W. C.

AU - Evans, G. W.

AU - Gerstein, H. C.

AU - Holman, R. R.

AU - Moritz, T. E.

AU - Neal, B. C.

AU - Ninomiya, T.

AU - Patel, A. A.

AU - Paul, S. K.

AU - Travert, F.

AU - Woodward, M.

PY - 2009/11

Y1 - 2009/11

N2 - Aims/hypothesis: Improved glucose control in type 2 diabetes is known to reduce the risk of microvascular events. There is, however, continuing uncertainty about its impact on macrovascular disease. The aim of these analyses was to generate more precise estimates of the effects of more-intensive, compared with less-intensive, glucose control on the risk of major cardiovascular events amongst patients with type 2 diabetes. Methods: A prospectively planned group-level meta-analysis in which characteristics of trials to be included, outcomes of interest, analyses and subgroup definitions were all pre-specified. Results: A total of 27,049 participants and 2,370 major vascular events contributed to the meta-analyses. Allocation to more-intensive, compared with less-intensive, glucose control reduced the risk of major cardiovascular events by 9% (HR 0.91, 95% CI 0.84-0.99), primarily because of a 15% reduced risk of myocardial infarction (HR 0.85, 95% CI 0.76-0.94). Mortality was not decreased, with non-significant HRs of 1.04 for all-cause mortality (95% CI 0.90-1.20) and 1.10 for cardiovascular death (95% CI 0.84-1.42). Intensively treated participants had significantly more major hypoglycaemic events (HR 2.48, 95% CI 1.91-3.21). Exploratory subgroup analyses suggested the possibility of a differential effect for major cardiovascular events in participants with and without macrovascular disease (HR 1.00, 95% CI 0.89-1.13, vs HR 0.84, 95% CI 0.74-0.94, respectively; interaction p=0.04). Conclusions/interpretation: Targeting more-intensive glucose lowering modestly reduced major macrovascular events and increased major hypoglycaemia over 4.4 years in persons with type 2 diabetes. The analyses suggest that glucose-lowering regimens should be tailored to the individual.

AB - Aims/hypothesis: Improved glucose control in type 2 diabetes is known to reduce the risk of microvascular events. There is, however, continuing uncertainty about its impact on macrovascular disease. The aim of these analyses was to generate more precise estimates of the effects of more-intensive, compared with less-intensive, glucose control on the risk of major cardiovascular events amongst patients with type 2 diabetes. Methods: A prospectively planned group-level meta-analysis in which characteristics of trials to be included, outcomes of interest, analyses and subgroup definitions were all pre-specified. Results: A total of 27,049 participants and 2,370 major vascular events contributed to the meta-analyses. Allocation to more-intensive, compared with less-intensive, glucose control reduced the risk of major cardiovascular events by 9% (HR 0.91, 95% CI 0.84-0.99), primarily because of a 15% reduced risk of myocardial infarction (HR 0.85, 95% CI 0.76-0.94). Mortality was not decreased, with non-significant HRs of 1.04 for all-cause mortality (95% CI 0.90-1.20) and 1.10 for cardiovascular death (95% CI 0.84-1.42). Intensively treated participants had significantly more major hypoglycaemic events (HR 2.48, 95% CI 1.91-3.21). Exploratory subgroup analyses suggested the possibility of a differential effect for major cardiovascular events in participants with and without macrovascular disease (HR 1.00, 95% CI 0.89-1.13, vs HR 0.84, 95% CI 0.74-0.94, respectively; interaction p=0.04). Conclusions/interpretation: Targeting more-intensive glucose lowering modestly reduced major macrovascular events and increased major hypoglycaemia over 4.4 years in persons with type 2 diabetes. The analyses suggest that glucose-lowering regimens should be tailored to the individual.

UR - http://www.scopus.com/inward/record.url?scp=70349881450&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70349881450&partnerID=8YFLogxK

U2 - 10.1007/s00125-009-1470-0

DO - 10.1007/s00125-009-1470-0

M3 - Article

VL - 52

SP - 2288

EP - 2298

JO - Diabetologia

JF - Diabetologia

SN - 0012-186X

IS - 11

ER -