Caution urged over intensive glucose control
Wednesday, 27 July 2011
Intensive glucose-lowering treatment in people with type 2 diabetes does not appear to reduce all-cause or cardiovascular mortality, shows new research. The meta-analysis, published on bmj.com, also showed a doubling of the risk of hypoglycaemia with more intensive treatment.
The authors warn that doctors should not prescribe intensive glucose-lowering treatment expecting it to reduce their patients’ cardiovascular risk.
People with type 2 diabetes have double the cardiovascular disease risk of their peers without diabetes, as well as a raised risk of microvascular complications. Yet studies into the effect of glucose-lowering treatment have not always shown clear benefits.
So researchers in France conducted a meta-analysis of 13 studies into glucose-lowering treatment, to see whether or not more intensive treatment could reduce patients’ risk of cardiovascular disease and microvascular complications. These studies included 34,533 people with diabetes – 16,218 on standard treatment and 18,315 on intensive treatment.
Intensive glucose-lowering treatment did not significantly improve all-cause or cardiovascular mortality. It did, however, reduce the risk of non-fatal heart attacks by 15% and of microalbuminuria by 10%.
The risk of severe hypoglycaemia was more than doubled by intensive glucose-lowering treatment.
The researchers warned: “Intensive glucose lowering treatment of type 2 diabetes should be considered with caution and therapeutic escalation should be limited.”
In an accompanying editorial, UK experts write: “The meta-analysis is consistent with earlier evidence that the cardiovascular benefit of intensive glucose lowering seems to be modest at best, and that glucose lowering is probably less efficacious and more difficult to achieve than lipid lowering and blood pressure control.
“A combined approach that targets glucose lowering, lipid lowering, and blood pressure control seems to be most beneficial, and available data also suggest a long-lasting beneficial effect on diabetes-related clinical events many years after an intensive regimen.”
They conclude that the most sensible treatment strategy will need to be determined on a patient-by-patient basis, carefully considering the absolute risks and benefits of more intensive therapy.