Curriculum in CardiologyGlycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: Meta-analysis of randomized trials
Section snippets
Literature search and eligibility criteria
We aimed to identify all randomized controlled comparisons of improved glycemic control that assessed macrovascular disease in types 1 and 2 DM. Using Cochrane methodology,15 we searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Register for relevant studies. We considered studies in any language. Electronic searches were supplemented by hand-searching of reference lists, reviews, relevant book chapters, conference abstracts, and specialist journals. We evaluated each study for
Identification of eligible studies and comparisons
We screened 1438 reports and excluded 1313. The remaining 125 reports, which reported on 14 different studies, were retrieved for detailed evaluation. Ten studies that included 14 randomized comparisons of intensified and conventional treatment were included (Figure 1). Eight comparisons had been performed in patients with type 1 DM5, 7, 8, 10, 11, 12 and 6 in patients with type 2 DM.6, 9, 22, 23 The DCCT in patients with type 1 DM5 and the Kumamoto study in patients with type 2 DM9 included 2
Discussion
In this systematic review and meta-analysis, we found that improved glycemic control translated into substantial reductions in macrovascular risk in type 1 DM while producing a smaller reduction in patients with type 2 DM. In type 1 DM, important beneficial effects were evident for cardiac and peripheral vascular events. In type 2 DM, substantial effects were observed for peripheral vascular disease and stroke, whereas cardiac events were not found to be reduced significantly. Of note, the
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We declare that we have no conflict of interest. This study was supported by grants from Novo Nordisk, Küsnacht, Switzerland, Roche Diagnostics, Rotkreuz, Switzerland, and Glaxo Smith Kline, Münchenbuchsee, Switzerland.