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Hasan R, Firwana B, Elraiyah T, Domecq JP, Prutsky G, Nabhan M, Prokop LJ, Henke P, Tsapas A, Montori VM, Murad MH, et al.
Journal of vascular surgery. Date of publication 2016 Feb 1;volume 63(2 Suppl):22S-28S.e1-2.
1. J Vasc Surg. 2016 Feb;63(2 Suppl):22S-28S.e1-2. doi: 10.1016/j.jvs.2015.10.005. A systematic review and meta-analysis of glycemic control for the prevention of diabetic foot syndrome. Hasan R(1), Firwana B(1), Elraiyah T(2), Domecq JP(3), Prutsky G(3), Nabhan M(2), Prokop LJ(4), Henke P(5), Tsapas A(6), Montori VM(7), Murad MH(8). Author information: (1)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Department of Internal Medicine, University of Missouri, Columbia, Mo. (2)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn. (3)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia (CONEVID), Lima, Peru. (4)Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn. (5)Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich. (6)Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece. (7)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minn. (8)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu. Comment in J Vasc Surg. 2016 Jul;64(1):264-5. J Vasc Surg. 2016 Jul;64(1):265. OBJECTIVE: The objective of this review was to synthesize the available randomized controlled trials (RCTs) estimating the relative efficacy and safety of intensive vs less intensive glycemic control in preventing diabetic foot syndrome. METHODS: We used the umbrella design (systematic review of systematic reviews) to identify eligible RCTs. Two reviewers determined RCT eligibility and extracted descriptive, methodologic, and diabetic foot outcome data. Random-effects meta-analysis was used to pool outcome data across studies, and the I(2) statistic was used to quantify heterogeneity. RESULTS: Nine RCTs enrolling 10,897 patients with type 2 diabetes were included and deemed to be at moderate risk of bias. Compared with less intensive glycemic control, intensive control (hemoglobin A1c, 6%-7.5%) was associated with a significant decrease in risk of amputation (relative risk [RR], 0.65; 95% confidence interval [CI], 0.45-0.94; I(2) = 0%). Intensive control was significantly associated with slower decline in sensory vibration threshold (mean difference, -8.27; 95% CI, -9.75 to -6.79). There was no effect on other neuropathic changes (RR, 0.89; 95% CI, 0.75-1.05; I(2) = 32%) or ischemic changes (RR, 0.92; 95% CI, 0.67-1.26; I(2) = 0%). The quality of evidence is likely moderate. CONCLUSIONS: Compared with less intensive glycemic control therapy, intensive control may decrease the risk of amputation in patients with diabetic foot syndrome. The reported risk reduction is likely overestimated because the trials were open and the decision to proceed with amputation could be influenced by glycemic control. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jvs.2015.10.005 PMID: 26804364 [Indexed for MEDLINE]
Appears in following Topics:
Diabetic Foot Ulcer - Treatment
Arterial Ulcer - Treatment
Arterial Ulcer - Treatment