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Cardiovascular Diabetology

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Open Access 01-12-2015 | Original investigation

HbA1c below 7 % as the goal of glucose control fails to maximize the cardiovascular benefits: a meta-analysis

Authors: Pin Wang, Rong Huang, Sen Lu, Wenqing Xia, Haixia Sun, Jie Sun, Rongrong Cai, Shaohua Wang

Published in: Cardiovascular Diabetology | Issue 1/2015

Abstract

Objective

Whether lowering glycosylated haemoglobin (HbA1c) level below 7.0 % improves macro-vascular outcomes in diabetes remains unclear. Here, we aimed to assess the effect of relatively tight glucose control resulting in a follow-up HbA1c level of less or more than 7.0 % on cardiovascular outcomes in diabetic patients.

Research design and methods

We systematically searched Medline, Web of science and Cochrane Library for prospective randomized controlled trials published between Jan 1, 1996 and July 1, 2015 that recorded cardiovascular outcome trials of glucose-lowering drugs or strategies in patients with type 2 diabetes mellitus.

Results

Data from 15 studies involving 88,266 diabetic patients with 4142 events of non-fatal myocardial infarction, 6997 of major cardiovascular events, 3517 of heart failure, 6849 of all-cause mortality, 2084 of non-fatal stroke, 3816 of cardiovascular death were included. A 7 % reduction of major cardiovascular events was observed only when relatively tight glucose control resulted in a follow-up HbA1c level above 7.0 % (OR 0.93, 95 % CI 0.88–0.98; I² = 33 %), however, the patients can benefit from reduction incidence of non-fatal myocardial infarction only when the follow-up HbA1c value below 7.0 % (OR 0.85, 95 % CI 0.74–0.96). Apart from the HbA1c value above 7.0 % (OR 1.22, 95 % CI 1.06–1.40), the application of thiazolidinediones (OR 1.39, 95 % CI 1.14–1.69) also increased the risk of heart failure, while the gliptins shows neutral effects to heart failure (OR 1.14, 95 % CI 0.97–1.34).

Conclusions

Relatively tight glucose control has some cardiovascular benefits. HbA1c below 7.0 % as the goal to maximize the cardiovascular benefits remains suspended.

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Title: HbA1c below 7 % as the goal of glucose control fails to maximize the cardiovascular benefits: a meta-analysis
Authors: Pin Wang
Rong Huang
Sen Lu
Wenqing Xia
Haixia Sun
Jie Sun
Rongrong Cai
Shaohua Wang
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Cardiovascular Diabetology / Issue 1/2015
Electronic ISSN: 1475-2840
DOI: https://doi.org/10.1186/s12933-015-0285-1

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Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

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Abstract

Objective

Research design and methods

Results

Conclusions

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