Intensive glucose control and macrovascular outcomes in type 2 diabetes
Identifieur interne : 008265 ( Main/Exploration ); précédent : 008264; suivant : 008266Intensive glucose control and macrovascular outcomes in type 2 diabetes
Auteurs : F. M. Turnbull [Australie] ; C. Abraira [États-Unis] ; R. J. Anderson [États-Unis] ; R. P. Byington [États-Unis] ; J. P. Chalmers [Australie] ; W. C. Duckworth [États-Unis] ; G. W. Evans [États-Unis] ; H. C. Gerstein [Canada] ; R. R. Holman [Royaume-Uni] ; T. E. Moritz [États-Unis] ; B. C. Neal [Australie] ; T. Ninomiya [Australie] ; A. A. Patel [Australie] ; S. K. Paul [Royaume-Uni] ; F. Travert [France] ; M. Woodward [Australie]Source :
- Diabetologia : (Berlin) [ 0012-186X ] ; 2009.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Glucose.
English descriptors
- KwdEn :
Abstract
Aims/hypothesis Improved glucose control in type 2 diabetes is known to reduce the risk of microvascular events. There is, however, continuing uncertainty about its impact on macrovascular disease. The aim of these analyses was to generate more precise estimates of the effects of more-intensive, compared with less-intensive, glucose control on the risk of major cardiovascular events amongst patients with type 2 diabetes. Methods A prospectively planned group-level meta-analysis in which characteristics of trials to be included, outcomes of interest, analyses and subgroup definitions were all pre-specified. Results A total of 27,049 participants and 2,370 major vascular events contributed to the meta-analyses. Allocation to more-intensive, compared with less-intensive, glucose control reduced the risk of major cardiovascular events by 9% (HR 0.91, 95% CI 0.84-0.99), primarily because of a 15% reduced risk of myocardial infarction (HR 0.85, 95% CI 0.76-0.94). Mortality was not decreased, with non-significant HRs of 1.04 for all-cause mortality (95% CI 0.90-1.20) and 1.10 0 for cardiovascular death (95% CI 0.84-1.42). Intensively treated participants had significantly more major hypoglycaemic events (HR 2.48, 95% CI 1.91-3.21). Exploratory subgroup analyses suggested the possibility of a differential effect for major cardiovascular events in participants with and without macrovascular disease (HR 1.00, 95% CI 0.89-1.13, vs HR 0.84, 95% CI 0.74-0.94, respectively; interaction p=0.04). Conclusionslinterpretation Targeting more-intensive glucose lowering modestly reduced major macrovascular events and increased major hypoglycaemia over 4.4 years in persons with type 2 diabetes. The analyses suggest that glucose-lowering regimens should be tailored to the individual.
Affiliations:
- Australie, Canada, France, Royaume-Uni, États-Unis
- Angleterre, Nouvelle-Galles du Sud, Oxfordshire, Île-de-France
- Oxford, Paris, Sydney
- Université de Sydney
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Neal</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney, PO Box M201, Missenden Rd</s1><s2>Sydney, NSW 2050</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Sydney, NSW 2050</wicri:noRegion><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Ninomiya, T" sort="Ninomiya, T" uniqKey="Ninomiya T" first="T." last="Ninomiya">T. Ninomiya</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney, PO Box M201, Missenden Rd</s1><s2>Sydney, NSW 2050</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Sydney, NSW 2050</wicri:noRegion><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Patel, A A" sort="Patel, A A" uniqKey="Patel A" first="A. A." last="Patel">A. A. 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Paul</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Oxford Centre for Diabetes, Endocrinology, and Metabolism</s1><s2>Oxford</s2><s3>GBR</s3><sZ>9 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region></placeName></affiliation></author><author><name sortKey="Travert, F" sort="Travert, F" uniqKey="Travert F" first="F." last="Travert">F. Travert</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Centre d'Investigations Cliniques, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique des Hôpitaux de Paris</s1><s2>Paris</s2><s3>FRA</s3><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Woodward, M" sort="Woodward, M" uniqKey="Woodward M" first="M." last="Woodward">M. 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M." last="Turnbull">F. M. Turnbull</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney, PO Box M201, Missenden Rd</s1><s2>Sydney, NSW 2050</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Sydney, NSW 2050</wicri:noRegion><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Abraira, C" sort="Abraira, C" uniqKey="Abraira C" first="C." last="Abraira">C. Abraira</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Miami Veterans Affairs Medical Center</s1><s2>Miami, FL</s2><s3>USA</s3><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Miami Veterans Affairs Medical Center</wicri:noRegion></affiliation></author><author><name sortKey="Anderson, R J" sort="Anderson, R J" uniqKey="Anderson R" first="R. J." last="Anderson">R. J. Anderson</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Hines Veterans Affairs Cooperative Studies Program Coordinating Center</s1><s2>Hines, IL</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Hines Veterans Affairs Cooperative Studies Program Coordinating Center</wicri:noRegion></affiliation></author><author><name sortKey="Byington, R P" sort="Byington, R P" uniqKey="Byington R" first="R. P." last="Byington">R. P. Byington</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Wake Forest University School of Medicine</s1><s2>Winston-Salem, NC</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Wake Forest University School of Medicine</wicri:noRegion></affiliation></author><author><name sortKey="Chalmers, J P" sort="Chalmers, J P" uniqKey="Chalmers J" first="J. P." last="Chalmers">J. P. Chalmers</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney, PO Box M201, Missenden Rd</s1><s2>Sydney, NSW 2050</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Sydney, NSW 2050</wicri:noRegion><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Duckworth, W C" sort="Duckworth, W C" uniqKey="Duckworth W" first="W. C." last="Duckworth">W. C. Duckworth</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Phoenix Veterans Affairs Health Care Center</s1><s2>Phoenix, AZ</s2><s3>USA</s3><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Phoenix Veterans Affairs Health Care Center</wicri:noRegion></affiliation></author><author><name sortKey="Evans, G W" sort="Evans, G W" uniqKey="Evans G" first="G. W." last="Evans">G. W. Evans</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Wake Forest University School of Medicine</s1><s2>Winston-Salem, NC</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Wake Forest University School of Medicine</wicri:noRegion></affiliation></author><author><name sortKey="Gerstein, H C" sort="Gerstein, H C" uniqKey="Gerstein H" first="H. C." last="Gerstein">H. C. Gerstein</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>McMaster University and Hamilton Health Sciences, Population Health Research Institute</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>8 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton, ON</wicri:noRegion></affiliation></author><author><name sortKey="Holman, R R" sort="Holman, R R" uniqKey="Holman R" first="R. R." last="Holman">R. R. Holman</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Oxford Centre for Diabetes, Endocrinology, and Metabolism</s1><s2>Oxford</s2><s3>GBR</s3><sZ>9 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region></placeName></affiliation></author><author><name sortKey="Moritz, T E" sort="Moritz, T E" uniqKey="Moritz T" first="T. E." last="Moritz">T. E. Moritz</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Hines Veterans Affairs Cooperative Studies Program Coordinating Center</s1><s2>Hines, IL</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Hines Veterans Affairs Cooperative Studies Program Coordinating Center</wicri:noRegion></affiliation></author><author><name sortKey="Neal, B C" sort="Neal, B C" uniqKey="Neal B" first="B. C." last="Neal">B. C. Neal</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney, PO Box M201, Missenden Rd</s1><s2>Sydney, NSW 2050</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Sydney, NSW 2050</wicri:noRegion><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Ninomiya, T" sort="Ninomiya, T" uniqKey="Ninomiya T" first="T." last="Ninomiya">T. Ninomiya</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney, PO Box M201, Missenden Rd</s1><s2>Sydney, NSW 2050</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Sydney, NSW 2050</wicri:noRegion><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Patel, A A" sort="Patel, A A" uniqKey="Patel A" first="A. A." last="Patel">A. A. Patel</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney, PO Box M201, Missenden Rd</s1><s2>Sydney, NSW 2050</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Sydney, NSW 2050</wicri:noRegion><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Paul, S K" sort="Paul, S K" uniqKey="Paul S" first="S. K." last="Paul">S. K. Paul</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Oxford Centre for Diabetes, Endocrinology, and Metabolism</s1><s2>Oxford</s2><s3>GBR</s3><sZ>9 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region></placeName></affiliation></author><author><name sortKey="Travert, F" sort="Travert, F" uniqKey="Travert F" first="F." last="Travert">F. Travert</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Centre d'Investigations Cliniques, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique des Hôpitaux de Paris</s1><s2>Paris</s2><s3>FRA</s3><sZ>15 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Woodward, M" sort="Woodward, M" uniqKey="Woodward M" first="M." last="Woodward">M. Woodward</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney, PO Box M201, Missenden Rd</s1><s2>Sydney, NSW 2050</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Sydney, NSW 2050</wicri:noRegion><orgName type="university">Université de Sydney</orgName><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Diabetologia : (Berlin)</title><title level="j" type="abbreviated">Diabetologia : (Berl.)</title><idno type="ISSN">0012-186X</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Diabetologia : (Berlin)</title><title level="j" type="abbreviated">Diabetologia : (Berl.)</title><idno type="ISSN">0012-186X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Glucose</term><term>Hypoglycemia</term><term>Type 2 diabetes</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Glucose</term><term>Hypoglycémie</term><term>Diabète de type 2</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Glucose</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Aims/hypothesis Improved glucose control in type 2 diabetes is known to reduce the risk of microvascular events. There is, however, continuing uncertainty about its impact on macrovascular disease. The aim of these analyses was to generate more precise estimates of the effects of more-intensive, compared with less-intensive, glucose control on the risk of major cardiovascular events amongst patients with type 2 diabetes. Methods A prospectively planned group-level meta-analysis in which characteristics of trials to be included, outcomes of interest, analyses and subgroup definitions were all pre-specified. Results A total of 27,049 participants and 2,370 major vascular events contributed to the meta-analyses. Allocation to more-intensive, compared with less-intensive, glucose control reduced the risk of major cardiovascular events by 9% (HR 0.91, 95% CI 0.84-0.99), primarily because of a 15% reduced risk of myocardial infarction (HR 0.85, 95% CI 0.76-0.94). Mortality was not decreased, with non-significant HRs of 1.04 for all-cause mortality (95% CI 0.90-1.20) and 1.10 0 for cardiovascular death (95% CI 0.84-1.42). Intensively treated participants had significantly more major hypoglycaemic events (HR 2.48, 95% CI 1.91-3.21). Exploratory subgroup analyses suggested the possibility of a differential effect for major cardiovascular events in participants with and without macrovascular disease (HR 1.00, 95% CI 0.89-1.13, vs HR 0.84, 95% CI 0.74-0.94, respectively; interaction p=0.04). Conclusionslinterpretation Targeting more-intensive glucose lowering modestly reduced major macrovascular events and increased major hypoglycaemia over 4.4 years in persons with type 2 diabetes. The analyses suggest that glucose-lowering regimens should be tailored to the individual.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Canada</li><li>France</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Nouvelle-Galles du Sud</li><li>Oxfordshire</li><li>Île-de-France</li></region><settlement><li>Oxford</li><li>Paris</li><li>Sydney</li></settlement><orgName><li>Université de Sydney</li></orgName></list><tree><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Turnbull, F M" sort="Turnbull, F M" uniqKey="Turnbull F" first="F. M." last="Turnbull">F. M. Turnbull</name></region><name sortKey="Chalmers, J P" sort="Chalmers, J P" uniqKey="Chalmers J" first="J. P." last="Chalmers">J. P. Chalmers</name><name sortKey="Neal, B C" sort="Neal, B C" uniqKey="Neal B" first="B. C." last="Neal">B. C. Neal</name><name sortKey="Ninomiya, T" sort="Ninomiya, T" uniqKey="Ninomiya T" first="T." last="Ninomiya">T. Ninomiya</name><name sortKey="Patel, A A" sort="Patel, A A" uniqKey="Patel A" first="A. A." last="Patel">A. A. Patel</name><name sortKey="Woodward, M" sort="Woodward, M" uniqKey="Woodward M" first="M." last="Woodward">M. Woodward</name></country><country name="États-Unis"><noRegion><name sortKey="Abraira, C" sort="Abraira, C" uniqKey="Abraira C" first="C." last="Abraira">C. Abraira</name></noRegion><name sortKey="Anderson, R J" sort="Anderson, R J" uniqKey="Anderson R" first="R. J." last="Anderson">R. J. Anderson</name><name sortKey="Byington, R P" sort="Byington, R P" uniqKey="Byington R" first="R. P." last="Byington">R. P. Byington</name><name sortKey="Duckworth, W C" sort="Duckworth, W C" uniqKey="Duckworth W" first="W. C." last="Duckworth">W. C. Duckworth</name><name sortKey="Evans, G W" sort="Evans, G W" uniqKey="Evans G" first="G. W." last="Evans">G. W. Evans</name><name sortKey="Moritz, T E" sort="Moritz, T E" uniqKey="Moritz T" first="T. E." last="Moritz">T. E. Moritz</name></country><country name="Canada"><noRegion><name sortKey="Gerstein, H C" sort="Gerstein, H C" uniqKey="Gerstein H" first="H. C." last="Gerstein">H. C. Gerstein</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Holman, R R" sort="Holman, R R" uniqKey="Holman R" first="R. R." last="Holman">R. R. Holman</name></region><name sortKey="Paul, S K" sort="Paul, S K" uniqKey="Paul S" first="S. K." last="Paul">S. K. Paul</name></country><country name="France"><region name="Île-de-France"><name sortKey="Travert, F" sort="Travert, F" uniqKey="Travert F" first="F." last="Travert">F. Travert</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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