Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Drugs
Published in: Drugs 17/2010

01-12-2010 | Review Article

Influence of Intensive versus Conventional Glucose Control on Microvascular and Macrovascular Complications in Type 1 and 2 Diabetes Mellitus

Authors: Taina K. Mattila, Professor Anthonius de Boer

Published in: Drugs | Issue 17/2010

Login to get access

Abstract

In type 1 and 2 diabetes mellitus patients, hyperglycaemia is independently related to the development of microvascular and macrovascular complications. Glycaemic targets and the benefits of intensive versus conventional glucose control are under debate. The purpose of this review is to provide an overview of the randomized controlled trials and meta-analyses comparing the effects of intensive versus conventional glucose control on microvascular and macrovascular complications in type 1 and 2 diabetes.
MEDLINE and Cochrane database searches were performed with a limit on randomized controlled trials or meta-analysis and keywords related to glucose control and diabetes. In addition, related articles and reference lists of relevant articles and guidelines were reviewed.
Nine randomized controlled trials, three in type 1 and six in type 2 diabetes, and four meta-analyses in type 2 diabetes were reviewed. These studies included more than 30 000 patients. On the basis of these trials and metaanalyses, it can be concluded that intensive glucose control has a beneficial effect on microvascular complications (retinopathy, nephropathy, neuropathy) in both type 1 and type 2 diabetes patients. The risk reduction of developing a microvascular complication varied between 25% and 76%. Particularly in patients with type 2 diabetes, there was a 10–15% decrease in nonfatal myocardial infarction with intensive glucose control, but no effect on stroke, cardiovascular death or all-cause mortality was observed. There was a beneficial effect of intensive glucose control on cardiovascular disease in patients with type 1 diabetes in only one trial. In all studies, intensive glucose control was associated with at least twice the risk for serious hypoglycaemia than the conventional-control group.
In conclusion, compared with conventional glucose control, intensive glucose control is associated with fewer microvascular complications in both type 1 and type 2 diabetes, a decrease in coronary events, especially in type 2 diabetes, and more serious hypoglycaemia.
Literature
1.
WHO. Diabetes Action Now: an initiative of the World Health Organization and the International Diabetes Federation. Geneva: WHO, 2004
2.
Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes 2008; 26: 77–82CrossRef
3.
4.
Laakso M. Hyperglycaemia and cardiovascular disease in type 2 diabetes. Diabetes 1999; 48: 937–42PubMedCrossRef
5.
Gerstein HC, Pogue J, Mann JFE, et al. The relationship between dysglycaemia and cardiovascular and renal risk in diabetic and non-diabetic participants in the HOPE study: a prospective epidemiological analysis. Diabetologia 2005; 48: 1749–55PubMedCrossRef
6.
Khaw KT, Wareham N, Bingham S, et al. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 2004; 141: 413–20PubMed
7.
Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated haemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004; 141: 421–31PubMed
8.
Stettler C, Alleman S, Jüni P, et al. Glycemic control and macrovascular disease in type 1 and 2 diabetes mellitus: meta-analysis of randomized studies. Am Heart J 2006; 152: 27–38PubMedCrossRef
9.
Fox CS, Coacy S, Sorlie PD, et al. Increasing cardiovascular disease burden due to diabetes mellitus: the Framingham Heart Study. Circulation 2007; 115: 1544–50PubMedCrossRef
10.
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–86CrossRef
11.
Reichard P, Nilsson BY, Rosenqvist U. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N Engl J Med 1993; 329: 304–9PubMedCrossRef
12.
Microalbuminuria Collaborative Study Group. Intensive therapy and progression to clinical albuminuria in patients with insulin dependent diabetes mellitus and microalbuminuria. BMJ 1995; 311: 973–7CrossRef
13.
Lasker RD. The Diabetes Control and Complications Trial: implications for policy and practice. N Engl J Med 1993; 329: 1035–6PubMedCrossRef
14.
The Diabetes Control and Complications Trial Research Group/Epidemiology of Diabetes Interventions and Complications Research Group. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med 2000; 342(6): 381–9CrossRef
15.
The Diabetes Control and Complications Trial Research Group/Epidemiology of Diabetes Interventions and Complications Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005; 353: 2643–53CrossRef
16.
Chaturvedi N, Fuller JH. Effect of intensive treatment in insulin dependent diabetes mellitus with microalbuminuria: sample size was too small [letter]. BMJ 1996; 312: 253–4PubMedCrossRef
17.
Bender R, Sawicki PT. Effect of intensive treatment in insulin dependent diabetes mellitus with microalbuminuria: interpretation of study’s results is open to criticism [letter]. BMJ 1996; 312: 254PubMedCrossRef
18.
Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract 1995; 28: 103–17PubMedCrossRef
19.
UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–53CrossRef
20.
UK Prospective Diabetes Study Group. Intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes. Lancet 1998; 352: 854–65CrossRef
21.
The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545–59CrossRef
22.
The ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358: 2560–72CrossRef
23.
Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 160: 129–39CrossRef
24.
25.
UK Prospective Diabetes Study Group. UK Prospective Diabetes Study (UKPDS) VIII: study design, progress and performance. Diabetologia 1991; 34: 877–90CrossRef
26.
Ismail-Beigi F, Craven T, Banerij MA, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomized trial. Lancet 2010; 376: 419–30PubMedCrossRef
27.
American Diabetes Association. Standards of medical care in diabetes — 2009. Diabetes Care 2009; 32 Suppl. 1: S13–61CrossRef
28.
Dluhy RG, McMahon GT. Intensive glycemic control in the ACCORD and ADVANCE trials. N Engl J Med 2008; 358: 2630–3PubMedCrossRef
29.
30.
Pop-Busui R, Evans GW, Gerstein HC, et al. Effects of cardiac autonomic dysfunction on mortality risk in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Diabetes Care 2010; 33(7): 1578–84PubMedCrossRef
31.
Riddle MC, Ambrosius WT, Brillon DJ, et al. Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial. Diabetes Care 2010; 33(5): 983–90PubMedCrossRef
32.
Calles-Escandón J, Lovato LC, Simons-Morton DG, et al. Effect of intensive compared with standard glycemia treatment strategies on mortality by baseline subgroup characteristics: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Diabetes Care 2010; 33(4): 721–7PubMedCrossRef
33.
Bonds DE, Miller ME, Bergenstal RM, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ 2009; 339: b4909
34.
Miller ME, Bonds DE, Gerstein HC, et al. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. BMJ 2009; 339: b5444CrossRef
35.
Banarer S. Glucose control and vascular complications in type 2 diabetes [letter]. N Engl J Med 2009; 360: 2031PubMedCrossRef
36.
Luan FL. Glucose control and vascular complications in type 2 diabetes. N Engl J Med 2009; 360: 2031–2PubMedCrossRef
37.
Ray KK, Seshasai SR, Wijesuriya S, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet 2009; 373(9677): 1765–72PubMedCrossRef
38.
Ma J, Yang W, Fang N, et al. The association between intensive glycemic control and vascular complications in type 2 diabetes patients. Nutr Metab Cardiovasc Dis 2009; 19(9): 596–603PubMedCrossRef
39.
Kelly TN, Bazzano LA, Fonseca VA, et al. Systematic review: glucose control and cardiovascular disease in type 2 diabetes. Ann Intern Med 2009; 151(6): 394–403PubMed
40.
Turnbull FM, Abraira C, Anderson RJ, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia 2009; 52: 2288–98PubMedCrossRef
41.
Dormandy JA, Charbonnel B, Eckland DJ, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitA-zone Clinical Trial In macro Vascular Events): a randomized controlled trial. Lancet 2005; 366(9492): 1279–89PubMedCrossRef
42.
Abraira C, Colwell J, Nuttal F, et al. Cardiovascular events and correlates in the veterans affairs diabetes feasibility trial: Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes. Arch Intern Med 1997; 157(2): 181–8PubMedCrossRef
43.
Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348(5): 383–93PubMedCrossRef
44.
Chaggar PS, Shaw SM, Williams SG. Review article: thiazolidinediones and heart failure. Diab Vasc Dis Res 2009; 6: 146–52PubMedCrossRef
45.
Akalin S, Berntorp K, Ceriello A, et al. Intensive glucose therapy and clinical implications of recent data: a consensus statement from the Global Task Force on Glycaemic Control. Int J Clin Pract 2009; 63(10): 1421–5PubMedCrossRef
46.
Brown A, Reynolds LR, Bruemmer D. Intensive glycemic control and cardiovascular disease: an update. Nat Rev Cardiol 2010; 7(7): 369–75PubMedCrossRef
Metadata
Title
Influence of Intensive versus Conventional Glucose Control on Microvascular and Macrovascular Complications in Type 1 and 2 Diabetes Mellitus
Authors
Taina K. Mattila
Professor Anthonius de Boer
Publication date
01-12-2010
Publisher
Springer International Publishing
Published in
Drugs / Issue 17/2010
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI
https://doi.org/10.2165/11585220-000000000-00000

Other articles of this Issue 17/2010

Drugs 17/2010 Go to the issue

Adis Drug Evaluation

Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate Single-Tablet Regimen (Atripla®)

Leading Article

Drugs in Development for Tuberculosis

Adis Drug Profile

Trastuzumab

Adis Drug Profile

Fentanyl Sublingual

Adis Drug Evaluation

Olanzapine Long-Acting Injection

Review Article

Triple-Negative Breast Cancer