Diabetology, Careggi Hospital and University of Florence, Italy.
Diabetes Centre District 3, Azienda Sanitaria Universitaria Integrata di Trieste, Via Puccini 48/50, 34100, Trieste, Italy.
Nutr Metab Cardiovasc Dis. 2021 Aug 26;31(9):2539-2546. doi: 10.1016/j.numecd.2021.05.010. Epub 2021 May 24.
Different guidelines provide similar, but not identical, therapeutic targets for HbA1c in type 2 diabetes. These targets can also depend from the different pharmacological strategies adopted for intensifying glycemic control.
This meta-analysis includes randomized trials adopting any pharmacological regimen for intensifying glycemic control in T2DM (versus standard of care/placebo), with a trial duration ≥2 years and a between-group HbA1c difference≥0.5%. The primary outcome was to assess the effects of the improvement of glycemic control on major cardiovascular events (MACE), ocular and renal complications, and severe hypoglycemia. Mantel-Haenszel odds ratios (MH-OR) with 95% Confidence Intervals were calculated for all the outcomes considered. We included 13 trials fulfilling the inclusion criteria. The improvement of glycemic control was associated with a lower risk of MACE (MH-OR:0.89 [95%CI 0.85-0.94]) and renal adverse events (MH-OR 0.73 [0.65-0.82]), but not all-cause mortality (MH-OR 0.95 [0.88-1.01]) and ocular adverse complications (MH-OR 0.94 [0.72-1.22]). For glucose-lowering drugs inducing hypoglycemia, a protective effect on the risk of microvascular complications, but not of MACE and all-cause mortality, was observed only for HbA1c ≤ 48 mmol/mol, but with higher risk of severe hypoglycaemia (MH-OR 2.72 [1.79-4.13]). Drugs not inducing hypoglycaemia were associated with a reduction of MACE, renal adverse events, and all-cause mortality, for HbA1c< 7% (no data for lower targets).
The present meta-analysis show that the improvement of glycemic control with drugs not inducing hypoglycemia is associated with a reduction in the risk of long-term chronic vascular and renal complications, and all-cause mortality.
不同的指南为 2 型糖尿病患者的糖化血红蛋白（HbA1c）提供了相似但不完全相同的治疗目标。这些目标也可能取决于为强化血糖控制而采用的不同药理策略。
本荟萃分析包括采用任何强化血糖控制的药理方案（与标准治疗/安慰剂相比）的随机试验，试验持续时间≥2 年，组间 HbA1c 差值≥0.5%。主要结局是评估改善血糖控制对主要心血管事件（MACE）、眼部和肾脏并发症以及严重低血糖的影响。所有考虑的结局均采用 Mantel-Haenszel 比值比（MH-OR）及其 95%置信区间进行评估。我们纳入了 13 项符合纳入标准的试验。改善血糖控制与 MACE 风险降低相关（MH-OR：0.89 [95%CI 0.85-0.94]）和肾脏不良事件（MH-OR 0.73 [0.65-0.82]），但与全因死亡率（MH-OR 0.95 [0.88-1.01]）和眼部不良并发症（MH-OR 0.94 [0.72-1.22]）无关。对于导致低血糖的降糖药物，仅在 HbA1c≤48mmol/mol 时观察到对微血管并发症风险的保护作用，但严重低血糖风险增加（MH-OR 2.72 [1.79-4.13]），而对 MACE 和全因死亡率无保护作用。不导致低血糖的药物与 HbA1c<7%（较低目标无数据）时 MACE、肾脏不良事件和全因死亡率的降低相关。
本荟萃分析表明，不导致低血糖的药物改善血糖控制与降低长期慢性血管和肾脏并发症以及全因死亡率的风险相关。
