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Prescribing Advice for GPs

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Glucose control and cardiovascular outcomes

The Lancet has published the results of a meta-analysis that aimed to assess whether intensive control of glucose reduces macrovascular events and all-cause mortality in individuals with type 2 diabetes.

The study selected five trials including data on 33,040 participants. Data were collected on non-fatal myocardial infarction, coronary heart disease (including fatal and non-fatal myocardial infarction), stroke and all-cause mortality. Average HbA1c was 0.9% lower in the intensive treatment group compared to the standard treatment group.

The analysis found statistically significant relative risk reductions in non-fatal myocardial infarction and coronary heart disease of 17% and 15% respectively. There was no difference in the rates of stroke or all-cause mortality.

The authors note several limitations of their analysis including differences in the study populations, insufficient data to allow subgroup analysis and the application of certain mathematical assumptions. It is also notable that four of the five studies reviewed were open label or unblinded.

The authors conclude that, "intensive compared with standard glycaemic control significantly reduces coronary events without an increased risk of death". It is also noted that stronger evidence for all-cause mortality reduction exists for lipid-lowering treatment and blood pressure reduction making these interventions crucially important.

Action: This analysis provides some reassurance that glucose control reduces some cardiovascular outcomes however blood pressure and lipid management remain the priority.

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