American Heart Journal
Volume 152, Issue 1 , Pages 27-38 , July 2006

Glycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: Meta-analysis of randomized trials

  • Christoph Stettler, MD

      Affiliations

    • Department of Social and Preventive Medicine, University of Bern, Switzerland
  • ,
  • Sabin Allemann

      Affiliations

    • Department of Social and Preventive Medicine, University of Bern, Switzerland
    • Division of Endocrinology and Diabetes, University of Bern, Switzerland
  • ,
  • Peter Jüni, MD

      Affiliations

    • Department of Social and Preventive Medicine, University of Bern, Switzerland
    • MRC Health Services Research Collaboration Department of Social Medicine, University of Bristol, UK
  • ,
  • Carole A. Cull, PhD

      Affiliations

    • Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
  • ,
  • Rury R. Holman, MD

      Affiliations

    • Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
  • ,
  • Matthias Egger, MD, MSc

      Affiliations

    • Department of Social and Preventive Medicine, University of Bern, Switzerland
    • MRC Health Services Research Collaboration Department of Social Medicine, University of Bristol, UK
  • ,
  • Stephan Krähenbühl, MD

      Affiliations

    • Department of Internal Medicine, University of Basel, Switzerland
  • ,
  • Peter Diem, PD

      Affiliations

    • Division of Endocrinology and Diabetes, University of Bern, Switzerland
    • Corresponding Author InformationReprint requests: Peter Diem, MD, Division of Endocrinology and Diabetes, University of Bern–Inselspital, 3010 Bern, Switzerland.

Received 5 July 2005 ,Accepted 14 September 2005.

References 

  1. Haffner SJ, Cassells H. Hyperglycemia as a cardiovascular risk factor. Am J Med. 2003;115(Suppl 8A):6S–11S
  2. Libby P, Plutzky J. Diabetic macrovascular disease: the glucose paradox?. Circulation. 2002;106:2760–2763
  3. Deckert T, Poulsen JE, Larsen M. Prognosis of diabetics with diabetes onset before the age of thirty-one. I. Survival, causes of death, and complications. Diabetologia. 1978;14:363–370
  4. Morrish NJ, Stevens LK, Head J, et al. A prospective study of mortality among middle-aged diabetic patients (the London Cohort of the WHO Multinational Study of Vascular Disease in Diabetics) I: causes and death rates. Diabetologia. 1990;33:538–541
  5. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329:977–986
  6. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:837–853
  7. Feldt-Rasmussen B, Mathiesen ER, Jensen T, et al. Effect of improved metabolic control on loss of kidney function in type 1 (insulin-dependent) diabetic patients: an update of the Steno studies. Diabetologia. 1991;34:164–170
  8. Reichard P, Pihl M. Mortality and treatment side-effects during long-term intensified conventional insulin treatment in the Stockholm Diabetes Intervention Study. Diabetes. 1994;43:313–317
  9. Shichiri M, Kishikawa H, Ohkubo Y, et al. Long-term results of the Kumamoto study on optimal diabetes control in type 2 diabetic patients. Diabetes Care. 2000;23(Suppl 2):B21–B29
  10. Verrillo A, de Teresa A, Martino C, et al. Long-term correction of hyperglycemia and progression of retinopathy in insulin dependent diabetes. A five-year randomized prospective study. Diabetes Res. 1988;8:71–76
  11. Holman RR, Dornan TL, Mayon-White V, et al. Prevention of deterioration of renal and sensory-nerve function by more intensive management of insulin-dependent diabetic patients. A two-year randomised prospective study. Lancet. 1983;1:204–208
  12. Intensive therapy and progression to clinical albuminuria in patients with insulin dependent diabetes mellitus and microalbuminuria. Microalbuminuria Collaborative Study Group, United Kingdom. BMJ. 1995;311:973–977
  13. Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Am J Cardiol. 1995;75:894–903
  14. Egger M, Davey Smith G. Meta-analysis: potentials and promise. BMJ. 1997;315:1371–1374
  15. Robinson KA, Dickersin K. Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol. 2002;31:150–153
  16. Juni P, Altman DG, Egger M. Systematic reviews in health care: assessing the quality of controlled clinical trials. BMJ. 2001;323:42–46
  17. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–1558
  18. Altman DG. Confidence intervals for the number needed to treat. BMJ. 1998;317:1309–1312
  19. Egger M, Davey Smith G, Minder C. Bias in meta-analysis detected by a simple, graphical test—authors reply. BMJ. 1998;316:470–471
  20. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634
  21. Thompson SG, Sharp SJ. Explaining heterogeneity in meta-analysis: a comparison of methods. Stat Med. 1999;18:2693–2708
  22. Abraira C, Colwell J, Nuttall F, et al. Cardiovascular events and correlates in the Veterans Affairs Diabetes Feasibility Trial. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes. Arch Intern Med. 1997;157:181–188
  23. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:854–865
  24. UK Prospective Diabetes Study (UKPDS). VIII. Study design, progress and performance. Diabetologia. 1991;34:877–890
  25. Huang ES, Meigs JB, Singer DE. The effect of interventions to prevent cardiovascular disease in patients with type 2 diabetes mellitus. Am J Med. 2001;111:633–642
  26. Lawson ML, Gerstein HC, Tsui E, et al. Effect of intensive therapy on early macrovascular disease in young individuals with type 1 diabetes. A systematic review and meta-analysis. Diabetes Care. 1999;22(Suppl 2):B35–B39
  27. Bartlett C, Davey P, Dieppe P, et al. Women, older persons, and ethnic minorities: factors associated with their inclusion in randomised trials of statins 1990 to 2001. Heart. 2003;89:327–328
  28. Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2004;141:421–431
  29. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998;317:703–713
  30. Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol. 1995;26:57–65
  31. Malmberg K, Ryden L, Wedel H, et al. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005;26:650–661
  32. Svensson AM, McGuire DK, Abrahamsson P, et al. Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events. Eur Heart J. 2005;26:1255–1261
  33. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002;287:2570–2581
  34. Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348:383–393
  35. Tan MH, Johns D, Strand J, et al. Sustained effects of pioglitazone vs. glibenclamide on insulin sensitivity, glycaemic control, and lipid profiles in patients with type 2 diabetes. Diabet Med. 2004;21:859–866
  36. Nesto R. C-reactive protein, its role in inflammation, type 2 diabetes and cardiovascular disease, and the effects of insulin-sensitizing treatment with thiazolidinediones. Diabet Med. 2004;21:810–817
  37. Dunn CJ, Peters DH. Metformin. A review of its pharmacological properties and therapeutic use in non–insulin-dependent diabetes mellitus. Drugs. 1995;49:721–749
  38. Giugliano D, De Rosa N, Di Maro G, et al. Metformin improves glucose, lipid metabolism, and reduces blood pressure in hypertensive, obese women. Diabetes Care. 1993;16:1387–1390
  39. Brownlee M. Glycation products and the pathogenesis of diabetic complications. Diabetes Care. 1992;15:1835–1843
  40. Baynes JW. Role of oxidative stress in development of complications in diabetes. Diabetes. 1991;40:405–412
  41. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: collaborative analysis Of Diagnostic criteria in Europe. Lancet. 1999;354:617–621
  42. Chiasson JL, Josse RG, Gomis R, et al. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA. 2003;290:486–494
  43. Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, (http://www.accordtrial.org/public/index.cfm), accessed August 22, 2005.

 We declare that we have no conflict of interest. This study was supported by grants from Novo Nordisk, Küsnacht, Switzerland, Roche Diagnostics, Rotkreuz, Switzerland, and Glaxo Smith Kline, Münchenbuchsee, Switzerland.

PII: S0002-8703(05)00870-7

doi: 10.1016/j.ahj.2005.09.015

American Heart Journal
Volume 152, Issue 1 , Pages 27-38 , July 2006