Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
Faculty of Public Health, College of Health Science, the Saudi Electronic University, Riyadh, Saudi Arabia.
Expert Rev Endocrinol Metab. 2023 Jan;18(1):95-110. doi: 10.1080/17446651.2023.2166489. Epub 2023 Jan 31.
The aim of study is to re-evaluate the risk-benefits of intensive glycemic control in the context of multi-factorial intervention in adults with T2D.
We searched Ovid MEDLINE, Embase, Cochrane, and CINHAL for randomized control trials comparing standard glucose targets to intensive glucose targets with pre-specified HbAlevels. Subgroup analysis was also performed to account for the inclusion of glucose only versus multi-factorial intervention trials. Results are reported as risk ratio (RR) and 95% confidence interval (CI).
Fifty-seven publications including 19 trials were included. Compared to conventional glycemic control, intensive glycemic control decreased the risk of non-fatal myocardial infarction (0.8, 0.7-0.91), macroalbuminuria (0.72, 0.5--0.87), microalbuminuria (0.67, 0.52-0.85), major amputation (0.6, 0.38-0.96), retinopathy (0.75 ,0.63-0.9), and nephropathy (0.78, 0.63-0.97). The risk of hypoglycemia increased with intensive glycemic control than conventional treatment (2.04, 1.34-3.1). No reduction in all-cause or cardiovascular mortality was observed. However, in the context of multifactorial intervention, intensive glucose control was associated with a significant reduction in all-cause mortality (0.74, 0.57-0.95).
Targeting HbA levels should be individualized based on the clinical status, balancing risks and benefits and potential risk for developing these complications among people with T2D.
本研究旨在多因素干预背景下，重新评估 2 型糖尿病成人强化血糖控制的风险效益。
我们在 Ovid MEDLINE、Embase、Cochrane 和 CINHAL 中检索了比较标准血糖目标与以预定义 HbA1c 水平为目标的强化血糖目标的随机对照试验。还进行了亚组分析，以说明仅包括血糖与多因素干预试验的情况。结果以风险比 (RR) 和 95%置信区间 (CI) 报告。
共纳入 57 篇文献，包括 19 项试验。与常规血糖控制相比，强化血糖控制降低了非致死性心肌梗死的风险 (0.8，0.7-0.91)、大蛋白尿 (0.72，0.5-0.87)、微量白蛋白尿 (0.67，0.52-0.85)、大截肢 (0.6，0.38-0.96)、视网膜病变 (0.75，0.63-0.9)和肾病 (0.78，0.63-0.97)的风险。与常规治疗相比，强化血糖控制增加了低血糖的风险 (2.04，1.34-3.1)。未观察到全因或心血管死亡率降低。然而，在多因素干预的情况下，强化血糖控制与全因死亡率显著降低相关 (0.74，0.57-0.95)。
针对 HbA1c 水平应根据患者的临床状况个体化制定，平衡风险和效益以及 2 型糖尿病患者发生这些并发症的潜在风险。
