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ObjectiveTo assess the benefits and harms of targeting intensive versus conventional glycaemic control in patients with type 1 diabetes mellitus.DesignA systematic review with meta-analyses and trial sequential analyses of randomised clinical trials.Data sourcesThe Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded and LILACS to January 2013.Study selectionRandomised clinical trials that prespecified different targets of glycaemic control in participants at any age with type 1 diabetes mellitus were included.Data extractionTwo authors independently assessed studies for inclusion and extracted data.Results18 randomised clinical trials included 2254 participants with type 1 diabetes mellitus. All trials had high risk of bias. There was no statistically significant effect of targeting intensive glycaemic control on all-cause mortality (risk ratio 1.16, 95% CI 0.65 to 2.08) or cardiovascular mortality (0.49, 0.19 to 1.24). Targeting intensive glycaemic control reduced the relative risks for the composite macrovascular outcome (0.63, 0.41 to 0.96; p=0.03), and nephropathy (0.37, 0.27 to 0.50; p<0.00001. The effect estimates of retinopathy, ketoacidosis and retinal photocoagulation were not consistently statistically significant between random and fixed effects models. The risk of severe hypoglycaemia was significantly increased with intensive glycaemic targets (1.40, 1.01 to 1.94). Trial sequential analyses showed that the amount of data needed to demonstrate a relative risk reduction of 10% were, in general, inadequate.ConclusionsThere was no significant effect towards improved all-cause mortality when targeting intensive glycaemic control compared with conventional glycaemic control. However, there may be beneficial effects of targeting intensive glycaemic control on the composite macrovascular outcome and on nephropathy, and detrimental effects on severe hypoglycaemia. Notably, the data for retinopathy and ketoacidosis were inconsistent. There was a severe lack of reporting on patient relevant outcomes, and all trials had poor bias control.

BackgroundWomen often wish to discuss their pregnancy symptoms with their GP. However, the two parties’ understanding of symptoms may not be aligned.AimTo examine to what degree a specific pregnancy-related symptom worried women in the first trimester and analyse the characteristics of the most worried women.Design & settingA cross-sectional study was performed in general practice in Denmark from 1 March 2015–15 August 2016.MethodWomen attending the first prenatal care visit completed a questionnaire about pregnancy-related physical symptoms and worries. Women were recruited from 125 GP practices and 294 GPs participated in the study. Further data were obtained from their pregnancy health record. Multivariable logistic regression analysis was used to assess the associations between the women’s worries and the severity of the symptoms, which were adjusted for age and parity.ResultsA total of 1508 women, aged 16–45 years, were included and 1455 completed the questionnaire. Nausea, vomiting, pelvic cavity pain, and back pain were the most common symptoms, and 88% reported having two or more symptoms simultaneously. Among the 1278 women reporting nausea, only 21% were worried, while 88% of the 252 women reporting vaginal bleeding were worried. Primigravidae (those pregnant for the first time) were significantly more worried about vomiting and nausea than multigravidae (those who have experienced pregnancy previously). Those aged >35 years were more worried about pelvic girdle pain and pelvic cavity pain than younger women.ConclusionPregnancy-related physical symptoms are frequent in the first trimester. The severity of worries depends on the symptom. Vaginal bleeding and pain give rise to the majority of severe worries, especially among young women.

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