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- W1604596593 abstract "Clinical guidelines differ regarding their recommended blood glucose targets for patients with type 1 diabetes and recent studies on patients with type 2 diabetes suggest that aiming at very low targets can increase the risk of mortality.To assess the effects of intensive versus conventional glycaemic targets in patients with type 1 diabetes in terms of long-term complications and determine whether very low, near normoglycaemic values are of additional benefit.A systematic literature search was performed in the databases The Cochrane Library, MEDLINE and EMBASE. The date of the last search was December 2012 for all databases.We included all randomised controlled trials (RCTs) that had defined different glycaemic targets in the treatment arms, studied patients with type 1 diabetes, and had a follow-up duration of at least one year.Two review authors independently extracted data, assessed studies for risk of bias, with differences resolved by consensus. Overall study quality was evaluated by the 'Grading of Recommendations Assessment, Development, and Evaluation' (GRADE) system. Random-effects models were used for the main analyses and the results are presented as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes.We identified 12 trials that fulfilled the inclusion criteria, including a total of 2230 patients. The patient populations varied widely across studies with one study only including children, one study only including patients after a kidney transplant, one study with newly diagnosed adult patients, and several studies where patients had retinopathy or microalbuminuria at baseline. The mean follow-up duration across studies varied between one and 6.5 years. The majority of the studies were carried out in the 1980s and all trials took place in Europe or North America. Due to the nature of the intervention, none of the studies could be carried out in a blinded fashion so that the risk of performance bias, especially for subjective outcomes such as hypoglycaemia, was present in all of the studies. Fifty per cent of the studies were judged to have a high risk of bias in at least one other category.Under intensive glucose control, the risk of developing microvascular complications was reduced compared to conventional treatment for a) retinopathy: 23/371 (6.2%) versus 92/397 (23.2%); RR 0.27 (95% CI 0.18 to 0.42); P < 0.00001; 768 participants; 2 trials; high quality evidence; b) nephropathy: 119/732 (16.3%) versus 211/743 (28.4%); RR 0.56 (95% CI 0.46 to 0.68); P < 0.00001; 1475 participants; 3 trials; moderate quality evidence; c) neuropathy: 29/586 (4.9%) versus 86/617 (13.9%); RR 0.35 (95% CI 0.23 to 0.53); P < 0.00001; 1203 participants; 3 trials; high quality evidence. Regarding the progression of these complications after manifestation, the effect was weaker (retinopathy) or possibly not existent (nephropathy: RR 0.79 (95% CI 0.37 to 1.70); P = 0.55; 179 participants with microalbuminuria; 3 trials; very low quality evidence); no adequate data were available regarding the progression of neuropathy. For retinopathy, intensive glucose control reduced the risk of progression in studies with a follow-up duration of at least two years (85/366 (23.2%) versus 154/398 (38.7%); RR 0.61 (95% CI 0.49 to 0.76); P < 0.0001; 764 participants; 2 trials; moderate quality evidence), while we found evidence for an initial worsening of retinopathy after only one year of intensive glucose control (17/49 (34.7%) versus 7/47 (14.9%); RR 2.32 (95% CI 1.16 to 4.63); P = 0.02; 96 participants; 2 trials; low quality evidence).Major macrovascular outcomes (stroke and myocardial infarction) occurred very rarely, and no firm evidence could be established regarding these outcome measures (low quality evidence).We found that intensive glucose control increased the risk for severe hypoglycaemia, however the results were heterogeneous and only the 'Diabetes Complications Clinical Trial' (DCCT) showed a clear increase in severe hypoglycaemic episodes under intensive treatment. A subgroup analysis according to the baseline haemoglobin A1c (HbA1c) of participants in the trials (low quality evidence) suggests that the risk of hypoglycaemia is possibly only increased for patients who started with relatively low HbA1c values (< 9.0%). Several of the included studies also showed a greater weight gain under intensive glucose control, and the risk of ketoacidosis was only increased in studies using insulin pumps in the intensive treatment group (very low quality evidence).Overall, all-cause mortality was very low in all studies (moderate quality evidence) except in one study investigating renal allograft as treatment for end-stage diabetic nephropathy. Health-related quality of life was only reported in the DCCT trial, showing no statistically significant differences between the intervention and comparator groups (moderate quality evidence). In addition, only the DCCT published data on costs, indicating that intensive glucose therapy control was highly cost-effective considering the reduction of potential diabetes complications (moderate quality evidence).Tight blood sugar control reduces the risk of developing microvascular diabetes complications. The evidence of benefit is mainly from studies in younger patients at early stages of the disease. Benefits need to be weighed against risks including severe hypoglycaemia, and patient training is an important aspect in practice. The effects of tight blood sugar control seem to become weaker once complications have been manifested. However, further research is needed on this issue. Furthermore, there is a lack of evidence from RCTs on the effects of tight blood sugar control in older patient populations or patients with macrovascular disease. There is no firm evidence for specific blood glucose targets and treatment goals need to be individualised taking into account age, disease progression, macrovascular risk, as well as the patient's lifestyle and disease management capabilities." @default.
- W1604596593 created "2016-06-24" @default.
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- W1604596593 date "2014-02-14" @default.
- W1604596593 modified "2023-10-10" @default.
- W1604596593 title "Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus" @default.
- W1604596593 cites W103485765 @default.
- W1604596593 cites W144782172 @default.
- W1604596593 cites W1502524639 @default.
- W1604596593 cites W172609984 @default.
- W1604596593 cites W1752045965 @default.
- W1604596593 cites W1915612727 @default.
- W1604596593 cites W1966816223 @default.
- W1604596593 cites W1967984409 @default.
- W1604596593 cites W1970692170 @default.
- W1604596593 cites W1972510976 @default.
- W1604596593 cites W1972659700 @default.
- W1604596593 cites W1973979095 @default.
- W1604596593 cites W1974785275 @default.
- W1604596593 cites W1974975370 @default.
- W1604596593 cites W1980781241 @default.
- W1604596593 cites W1981437476 @default.
- W1604596593 cites W1981682327 @default.
- W1604596593 cites W1981987143 @default.
- W1604596593 cites W1982610111 @default.
- W1604596593 cites W1983241344 @default.
- W1604596593 cites W1983269691 @default.
- W1604596593 cites W1984380886 @default.
- W1604596593 cites W1986931072 @default.
- W1604596593 cites W1990623352 @default.
- W1604596593 cites W1991647428 @default.
- W1604596593 cites W1992103610 @default.
- W1604596593 cites W1993018456 @default.
- W1604596593 cites W1994541327 @default.
- W1604596593 cites W1994752781 @default.
- W1604596593 cites W1995937915 @default.
- W1604596593 cites W1997048409 @default.
- W1604596593 cites W1997615334 @default.
- W1604596593 cites W1999162865 @default.
- W1604596593 cites W2000001040 @default.
- W1604596593 cites W2000480781 @default.
- W1604596593 cites W2001980043 @default.
- W1604596593 cites W2003510810 @default.
- W1604596593 cites W2003571862 @default.
- W1604596593 cites W2006175454 @default.
- W1604596593 cites W2006672342 @default.
- W1604596593 cites W2007003907 @default.
- W1604596593 cites W2012362230 @default.
- W1604596593 cites W2013848834 @default.
- W1604596593 cites W2014554878 @default.
- W1604596593 cites W2019165330 @default.
- W1604596593 cites W2020591896 @default.
- W1604596593 cites W2021446295 @default.
- W1604596593 cites W2025580679 @default.
- W1604596593 cites W2028433049 @default.
- W1604596593 cites W2034126007 @default.
- W1604596593 cites W2035018400 @default.
- W1604596593 cites W2039476368 @default.
- W1604596593 cites W2040961193 @default.
- W1604596593 cites W2043286890 @default.
- W1604596593 cites W2043314341 @default.
- W1604596593 cites W2044153289 @default.
- W1604596593 cites W2044293101 @default.
- W1604596593 cites W2046391772 @default.
- W1604596593 cites W2050826908 @default.
- W1604596593 cites W2051354670 @default.
- W1604596593 cites W2053488499 @default.
- W1604596593 cites W2053730760 @default.
- W1604596593 cites W2056160070 @default.
- W1604596593 cites W2058264310 @default.
- W1604596593 cites W2059089451 @default.
- W1604596593 cites W2059816869 @default.
- W1604596593 cites W2061852824 @default.
- W1604596593 cites W2066633683 @default.
- W1604596593 cites W2066676890 @default.
- W1604596593 cites W2066951928 @default.
- W1604596593 cites W2067679923 @default.
- W1604596593 cites W2070875172 @default.
- W1604596593 cites W2072040332 @default.
- W1604596593 cites W2072793263 @default.
- W1604596593 cites W2076556143 @default.
- W1604596593 cites W2078265244 @default.
- W1604596593 cites W2079260079 @default.
- W1604596593 cites W2080083219 @default.
- W1604596593 cites W2083911580 @default.
- W1604596593 cites W2084473470 @default.
- W1604596593 cites W2084811082 @default.
- W1604596593 cites W2085369605 @default.
- W1604596593 cites W2085546759 @default.
- W1604596593 cites W2088865109 @default.
- W1604596593 cites W2089770071 @default.
- W1604596593 cites W2090015923 @default.
- W1604596593 cites W2091340026 @default.
- W1604596593 cites W2094557444 @default.
- W1604596593 cites W2095720372 @default.