Glycaemic control and macrovascular and microvascular outcomes: A systematic review and meta‐analysis of trials investigating intensive glucose‐lowering strategies in people with type 2 diabetes
Authors' conclusion
In people with T2D, intensive glucose control was associated with a reduced risk of non-fatal MI and several microvascular outcomes, particularly retinopathy and nephropathy. The lack of an effect of intensive glucose-lowering on most macrovascular outcomes calls for a more comprehensive approach to managing cardiovascular risk factors alongside glycaemic control.
Study context
- Population
- People with T2D in RCTs identified from MEDLINE, Embase, the Cochrane Library and bibliographies up to August 2023
- Participants
- 51,469 people11 RCTs
- Comparison
- Intensive vs standard glucose-lowering strategies
- Intensive therapyn = 26,691
- Standard therapyn = 24,778reference
- Outcome
- Macrovascular and microvascular outcomes
Methodological detailsmeta-regression
- Meta-regression
Pooled result
As reported in the abstract
Intensive therapy vs Standard therapyHazard ratio (95% CI)
Non-fatal MI
0.84(0.75–0.94)
MACE
0.97(0.92–1.03)
Retinopathy
0.85(0.78–0.93)
Nephropathy
0.71(0.58–0.87)
Composite microvascular outcomes
0.88(0.77–1.00)
Further pooled results
Meta-regression: HbA1c reduction vs outcomes
- Modest evidence of inverse linear relationships between HbA1c reduction and MACE, non-fatal myocardial infarction (MI), stroke and retinopathy, not statistically significant
Original publication
Glycaemic control and macrovascular and microvascular outcomes: A systematic review and meta‐analysis of trials investigating intensive glucose‐lowering strategies in people with type 2 diabetes. Diabetes Obes Metab. Published 26 February 2024. doi:10.
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