Kelly Tanika N, Bazzano Lydia A, Fonseca Vivian A, Thethi Tina K, Reynolds Kristi, He Jiang
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA 70112, USA.
Ann Intern Med. 2009 Sep 15;151(6):394-403. doi: 10.7326/0003-4819-151-6-200909150-00137. Epub 2009 Jul 20.
Results from clinical trials examining the effect of intensive glucose control on cardiovascular disease have been conflicting.
To summarize clinical benefits and harms of intensive versus conventional glucose control for adults with type 2 diabetes.
Studies were retrieved by systematically searching the MEDLINE database (January 1950 to April 2009) with no language restrictions.
Two independent reviewers screened abstracts or full-text articles to identify randomized trials that compared clinical outcomes in patients with type 2 diabetes receiving intensive glucose control and those receiving conventional glucose control.
Two investigators independently abstracted data on study variables and outcomes, including severe hypoglycemia, cardiovascular disease, and all-cause mortality.
5 trials involving 27,802 adults were included. Intensive glucose targets were lower in the 3 most recent trials. Summary analyses showed that compared with conventional control, intensive glucose control reduced the risk for cardiovascular disease (relative risk [RR], 0.90 [95% CI, 0.83 to 0.98]; risk difference per 1000 patients per 5 years [RD], -15 [CI, -24 to -5]) but not cardiovascular death (RR, 0.97 [CI, 0.76 to 1.24]; RD, -3 [CI, -14 to 7]) or all-cause mortality (RR, 0.98 [CI, 0.84 to 1.15]; RD, -4 [CI, -17 to 10]). Intensive glucose control increased the risk for severe hypoglycemia (RR, 2.03 [CI, 1.46 to 2.81]; RD, 39 [CI, 7 to 71]). As was seen in the overall analyses, pooled findings from the early and more recent trials showed that intensive glucose control reduced the risk for cardiovascular disease and increased the risk for severe hypoglycemia.
Summary rather than individual data were pooled across trials.
Intensive glucose control reduced the risk for some cardiovascular disease outcomes (such as nonfatal myocardial infarction), did not reduce the risk for cardiovascular death or all-cause mortality, and increased the risk for severe hypoglycemia.
关于强化血糖控制对心血管疾病影响的临床试验结果一直存在矛盾。
总结强化血糖控制与传统血糖控制对2型糖尿病成人患者的临床益处和危害。
通过系统检索MEDLINE数据库（1950年1月至2009年4月）获取研究，无语言限制。
两名独立评审员筛选摘要或全文文章，以识别比较接受强化血糖控制和传统血糖控制的2型糖尿病患者临床结局的随机试验。
两名研究人员独立提取关于研究变量和结局的数据，包括严重低血糖、心血管疾病和全因死亡率。
纳入了5项涉及27,802名成年人的试验。最近的3项试验中强化血糖目标更低。汇总分析表明，与传统控制相比，强化血糖控制降低了心血管疾病风险（相对风险[RR]，0.90[95%CI，0.83至0.98]；每1000名患者每5年的风险差[RD]，-15[CI，-24至-5]），但未降低心血管死亡风险（RR，0.97[CI，0.76至1.24]；RD，-3[CI，-14至7]）或全因死亡率（RR，0.98[CI，0.84至1.15]；RD，-4[CI，-17至10]）。强化血糖控制增加了严重低血糖风险（RR，2.03[CI，1.46至2.81]；RD，39[CI，7至71]）。如在总体分析中所见，早期和近期试验的汇总结果表明，强化血糖控制降低了心血管疾病风险并增加了严重低血糖风险。
跨试验汇总的是摘要数据而非个体数据。
强化血糖控制降低了某些心血管疾病结局（如非致命性心肌梗死）的风险，未降低心血管死亡或全因死亡率的风险，且增加了严重低血糖风险。
