Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials
Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials
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DOI：
10.1016/s0140-6736(09)60697-8
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发表时间：
2009-05-23
期刊：
影响因子：
168.9
通讯作者：
Sattar, Naveed
中科院分区：
文献类型：
--
作者：
Ray, Kausik K.;Seshasai, Sreenivasa Rao Kondapally;Sattar, Naveed
背景：强化血糖控制是否能降低2型糖尿病患者的大血管事件和全因死亡率尚不清楚。我们对随机对照试验进行了荟萃分析，以确定强化治疗是否有益。方法：我们选择了5项前瞻性随机对照试验，共纳入33040名受试者，以评估强化降糖方案与标准方案相比对死亡和心血管结局的影响。我们收集了有关非致死性心肌梗死、冠心病（致死性和非致死性心肌梗死）、中风和全因死亡率事件的信息，并进行了随机效应荟萃分析，利用从每个试验的原始数据计算的优势比，获得临床结果的总效应估计。采用chi(2)和12统计量评估各试验的统计异质性。在约163000人-年的随访中，这5项试验提供了1497例非致死性心肌梗死、2318例冠心病、1127例卒中和2892例全因死亡的信息。接受强化治疗的参与者的平均血红蛋白A（1c）浓度（HbA(1c)）比接受标准治疗的参与者低0.9%。强化血糖控制导致非致死性心肌梗死事件减少17%（优势比0.83,95% CI 0.75-0.93），冠心病事件减少15%（0.85 - 0.77-0.93）。强化血糖控制对卒中事件（0.93,0.81-1.06）或全因死亡率（1.02,0.87-1.19）无显著影响。总体而言，与标准血糖控制相比，强化血糖控制可显著降低冠状动脉事件，而不增加死亡风险。然而，不同人群降低HbA（1c）的最佳机制、速度和程度可能不同。资金没有。
Background Whether intensive control of glucose reduces macrovascular events and all-cause mortality in individuals with type 2 diabetes mellitus is unclear. We undertook a meta-analysis of randomised controlled trials to determine whether intensive treatment is beneficial.Methods We selected five prospective randomised controlled trials of 33 040 participants to assess the effect of an intensive glucose-lowering regimen on death and cardiovascular outcomes compared with a standard regimen. We gathered information about events of non-fatal myocardial infarction, coronary heart disease (fatal and non-fatal myocardial infarction), stroke, and all-cause mortality and did a random-effects meta-analysis to obtain summary effect estimates for the clinical outcomes with use of odds ratios calculated from the raw data of every trial. Statistical heterogeneity across trials was assessed with the chi(2) and 12 statistics.Findings The five trials provided information on 1497 events of non-fatal myocardial infarction, 2318 of coronary heart disease, 1127 of stroke, and 2892 of all-cause mortality during about 163 000 person-years of follow-up. The mean haemoglobin A(1c) concentration (HbA(1c)) was 0.9% lower for participants given intensive treatment than for those given standard treatment. Intensive glycaemic control resulted in a 17% reduction in events of non-fatal myocardial infarction (odds ratio 0.83, 95% CI 0.75-0.93), and a 15% reduction in events of coronary heart disease (0.85 0.77-0.93). Intensive glycaemic control had no significant effect on events of stroke (0.93, 0.81-1.06) or all-cause mortality (1.02, 0.87-1.19).Interpretation Overall, intensive compared with standard glycaemic control significantly reduces coronary events without an increased risk of death. However, the optimum mechanism, speed, and extent of HbA(1c) reduction might be different in differing populations.Funding None.