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

Abstract

None.

Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes

“…Although pleiotropic effects have been inferred, improved glycemic control, lowering of blood pressure, decrease in intraglomerular pressure, reduction in albuminuria, and amelioration of volume overload are all plausible protective mechanisms. 4,[13][14][15][16][17][18][19][20][21][22][23] The effects on cardiovascular and renal outcomes observed within this program of two integrated trials are similar to those observed previously with this drug class. 5,6 The favorable direction of effect with respect to stroke observed in this trial program differs from a previously reported possible adverse effect on stroke risk.…”

Beating type 2 diabetes into remission

“…11 Reduced cardiac events have also been observed in patients with type 2 diabetes after bariatric surgery. 12 In contrast, some drug trials have indicated increased mortality when HbA 1c approaches normal levels, probably through hypoglycaemia provoking arrhythmias. 13 Look AHEAD, a trial of lifestyle intervention in patients with mean diabetes duration of five years, reported 11.5% remission at 12 months with 8.6% weight loss, but that proportion fell by about 30% annually.…”

Intensive glucose control in patients with diabetes prevents onset and progression of microalbuminuria, but effects on end-stage kidney disease are still uncertain

“…The absence of clear evidence for an effect differs from the absence of an effect, especially given the potential for large benefits as reported by the Diabetes Control and Complications Trial (DCCT), the United Kingdom Prospective Diabetes Study (UKPDS) and the Action in Diabetes and Vascular Disease Preteraaax and Diamicron Controlled Evaluation (ADVANCE) trial and their long-term post-trial follow-ups 1–4. Supporting this is a recent meta-analysis of individual participant data from the UKPDS, Veteran Affairs Diabetes Trial (VADT), Action to Control Cardiovascular Risk in Diabetes (ACCORD) and ADVANCE trials, reporting that intensive control resulted in a 20% risk reduction for the composite of ESKD, renal death and development of an estimated GFR (eGFR) <30 mL/min or macroalbuminuria 5. Given the rarity of and the time taken to develop ESKD, trials with longer term follow-up or conducted with high-risk groups are warranted.…”