Intensive glucose control and macrovascular outcomes in type 2 diabetes
Identifieur interne : 003526 ( PascalFrancis/Curation ); précédent : 003525; suivant : 003527Intensive 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.
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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></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></affiliation></author><author><name sortKey="Byington, R P" sort="Byington, R P" uniqKey="Byington R" first="R. P." last="Byington">R. P. 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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></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></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></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="1"><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></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></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="1"><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></affiliation></author><author><name sortKey="Ninomiya, T" sort="Ninomiya, T" uniqKey="Ninomiya T" first="T." last="Ninomiya">T. Ninomiya</name><affiliation wicri:level="1"><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></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="1"><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></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="1"><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></affiliation></author><author><name sortKey="Travert, F" sort="Travert, F" uniqKey="Travert F" first="F." last="Travert">F. Travert</name><affiliation wicri:level="1"><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></affiliation></author><author><name sortKey="Woodward, M" sort="Woodward, M" uniqKey="Woodward M" first="M." last="Woodward">M. Woodward</name><affiliation wicri:level="1"><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></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">09-0447384</idno><date when="2009">2009</date><idno type="stanalyst">PASCAL 09-0447384 INIST</idno><idno type="RBID">Pascal:09-0447384</idno><idno type="wicri:Area/PascalFrancis/Corpus">002A98</idno><idno type="wicri:Area/PascalFrancis/Curation">003526</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Intensive glucose control and macrovascular outcomes in type 2 diabetes</title><author><name sortKey="Turnbull, F M" sort="Turnbull, F M" uniqKey="Turnbull F" first="F. M." last="Turnbull">F. M. Turnbull</name><affiliation wicri:level="1"><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></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></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></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></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="1"><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></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></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></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></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="1"><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></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></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="1"><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></affiliation></author><author><name sortKey="Ninomiya, T" sort="Ninomiya, T" uniqKey="Ninomiya T" first="T." last="Ninomiya">T. Ninomiya</name><affiliation wicri:level="1"><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></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="1"><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></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="1"><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></affiliation></author><author><name sortKey="Travert, F" sort="Travert, F" uniqKey="Travert F" first="F." last="Travert">F. Travert</name><affiliation wicri:level="1"><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></affiliation></author><author><name sortKey="Woodward, M" sort="Woodward, M" uniqKey="Woodward M" first="M." last="Woodward">M. Woodward</name><affiliation wicri:level="1"><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></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><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0012-186X</s0></fA01><fA03 i2="1"><s0>Diabetologia : (Berl.)</s0></fA03><fA05><s2>52</s2></fA05><fA06><s2>11</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Intensive glucose control and macrovascular outcomes in type 2 diabetes</s1></fA08><fA11 i1="01" i2="1"><s1>TURNBULL (F. M.)</s1></fA11><fA11 i1="02" i2="1"><s1>ABRAIRA (C.)</s1></fA11><fA11 i1="03" i2="1"><s1>ANDERSON (R. J.)</s1></fA11><fA11 i1="04" i2="1"><s1>BYINGTON (R. P.)</s1></fA11><fA11 i1="05" i2="1"><s1>CHALMERS (J. P.)</s1></fA11><fA11 i1="06" i2="1"><s1>DUCKWORTH (W. C.)</s1></fA11><fA11 i1="07" i2="1"><s1>EVANS (G. W.)</s1></fA11><fA11 i1="08" i2="1"><s1>GERSTEIN (H. C.)</s1></fA11><fA11 i1="09" i2="1"><s1>HOLMAN (R. R.)</s1></fA11><fA11 i1="10" i2="1"><s1>MORITZ (T. E.)</s1></fA11><fA11 i1="11" i2="1"><s1>NEAL (B. C.)</s1></fA11><fA11 i1="12" i2="1"><s1>NINOMIYA (T.)</s1></fA11><fA11 i1="13" i2="1"><s1>PATEL (A. A.)</s1></fA11><fA11 i1="14" i2="1"><s1>PAUL (S. K.)</s1></fA11><fA11 i1="15" i2="1"><s1>TRAVERT (F.)</s1></fA11><fA11 i1="16" i2="1"><s1>WOODWARD (M.)</s1></fA11><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></fA14><fA14 i1="02"><s1>Miami Veterans Affairs Medical Center</s1><s2>Miami, FL</s2><s3>USA</s3><sZ>2 aut.</sZ></fA14><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></fA14><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></fA14><fA14 i1="05"><s1>Phoenix Veterans Affairs Health Care Center</s1><s2>Phoenix, AZ</s2><s3>USA</s3><sZ>6 aut.</sZ></fA14><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></fA14><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></fA14><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></fA14><fA20><s1>2288-2298</s1></fA20><fA21><s1>2009</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>13012</s2><s5>354000170086090060</s5></fA43><fA44><s0>0000</s0><s1>© 2009 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>18 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>09-0447384</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Diabetologia : (Berlin)</s0></fA64><fA66 i1="01"><s0>DEU</s0></fA66><fC01 i1="01" l="ENG"><s0>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.</s0></fC01><fC02 i1="01" i2="X"><s0>002B21E01A</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Glucose</s0><s2>NK</s2><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Glucose</s0><s2>NK</s2><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Glucosa</s0><s2>NK</s2><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Hypoglycémie</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Hypoglycemia</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Hipoglicemia</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Diabète de type 2</s0><s2>NM</s2><s5>09</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Type 2 diabetes</s0><s2>NM</s2><s5>09</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Diabetes de tipo 2</s0><s2>NM</s2><s5>09</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Endocrinopathie</s0><s5>20</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Endocrinopathy</s0><s5>20</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Endocrinopatía</s0><s5>20</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Maladie métabolique</s0><s5>21</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Metabolic diseases</s0><s5>21</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Metabolismo patología</s0><s5>21</s5></fC07><fN21><s1>327</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist></record>Pour manipuler ce document sous Unix (Dilib)
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