Zoungas S, Arima H, Gerstein HC, Holman RR, Woodward M, Reaven P, Hayward RA, Craven T, Coleman RL, Chalmers J, Collaborators on Trials of Lowering Glucose (CONTROL) group., et al.
The lancet. Diabetes & endocrinology. Date of publication 2017 Jun 1;volume 5(6):431-437.
1. Lancet Diabetes Endocrinol. 2017 Jun;5(6):431-437. doi:
10.1016/S2213-8587(17)30104-3. Epub 2017 Mar 30.
Effects of intensive glucose control on microvascular outcomes in patients with
type 2 diabetes: a meta-analysis of individual participant data from randomised
controlled trials.
Zoungas S(1), Arima H(2), Gerstein HC(3), Holman RR(4), Woodward M(5), Reaven
P(6), Hayward RA(7), Craven T(8), Coleman RL(4), Chalmers J(9); Collaborators on
Trials of Lowering Glucose (CONTROL) group.
Author information:
(1)The George Institute for Global Health, University of Sydney, Sydney, NSW,
Australia; School of Public Health and Preventive Medicine, Monash University,
Melbourne, VIC, Australia. Electronic address: szoungas@georgeinstitute.org.au.
(2)The George Institute for Global Health, University of Sydney, Sydney, NSW,
Australia; Department of Preventive Medicine and Public Health, Fukuoka
University, Fukuoka, Japan.
(3)Department of Medicine and Population Health Research Institute, McMaster
University and Hamilton Health Sciences, Hamilton, ON, Canada.
(4)Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and
Metabolism, University of Oxford, Oxford, UK.
(5)The George Institute for Global Health, University of Sydney, Sydney, NSW,
Australia; The George Institute for Global Health, University of Oxford, Oxford,
UK; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
(6)Phoenix VA Health Care System, Phoenix, AZ, USA.
(7)Ann Arbor VA Health Care System, Ann Arbor, MI, USA.
(8)Department of Biostatistical Sciences, Wake Forest School of Medicine,
Winston-Salem, NC, USA.
(9)The George Institute for Global Health, University of Sydney, Sydney, NSW,
Australia.
Comment in
Lancet Diabetes Endocrinol. 2017 Jun;5(6):405-407.
Lancet Diabetes Endocrinol. 2017 Aug;5(8):579.
Lancet Diabetes Endocrinol. 2017 Aug;5(8):580.
BACKGROUND: Intensive glucose control is understood to prevent complications in
adults with type 2 diabetes. We aimed to more precisely estimate the effects of
more intensive glucose control, compared with less intensive glucose control, on
the risk of microvascular events.
METHODS: In this meta-analysis, we obtained de-identified individual participant
data from large-scale randomised controlled trials assessing the effects of more
intensive glucose control versus less intensive glucose control in adults with
type 2 diabetes, with at least 1000 patient-years of follow-up in each treatment
group and a minimum of 2 years average follow-up on randomised treatment. The
prespecified and standardised primary outcomes were kidney events (a composite of
end-stage kidney disease, renal death, development of an estimated glomerular
filtration rate <30 mL/min per 1·73m2, or development of overt diabetic
nephropathy), eye events (a composite of requirement for retinal photocoagulation
therapy or vitrectomy, development of proliferative retinopathy, or progression
of diabetic retinopathy), and nerve events (a composite of new loss of vibratory
sensation, ankle reflexes, or light touch). We used a random-effects model to
calculate overall estimates of effect.
FINDINGS: We included four trials (ACCORD, ADVANCE, UKPDS, and VADT) with 27 049
participants. 1626 kidney events, 795 eye events, and 7598 nerve events were
recorded during the follow-up period (median 5·0 years, IQR 4·5-5·0). Compared
with less intensive glucose control, more intensive glucose control resulted in
an absolute difference of -0·90% (95% CI -1·22 to -0·58) in mean HbA1c at
completion of follow-up. The relative risk was reduced by 20% for kidney events
(hazard ratio 0·80, 95% CI 0·72 to 0·88; p<0·0001) and by 13% for eye events
(0·87, 0·76 to 1·00; p=0·04), but was not reduced for nerve events (0·98, 0·87 to
1·09; p=0·68).
INTERPRETATION: More intensive glucose control over 5 years reduced both kidney
and eye events. Glucose lowering remains important for the prevention of
long-term microvascular complications in adults with type 2 diabetes.
FUNDING: None.
Copyright © 2017 Elsevier Ltd. All rights reserved.
DOI: 10.1016/S2213-8587(17)30104-3
PMID: 28365411 [Indexed for MEDLINE]
