Friday, November 25, 2011

Glycemic control and diabetes: today's evidence

This paper has the potential to be pretty important:

Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials

The article is free online but let me quote from the conclusion:

Intensive glycaemic control does not seem to reduce all cause mortality in patients with type 2 diabetes. Data available from randomised clinical trials remain insufficient to prove or refute a relative risk reduction for cardiovascular mortality, non-fatal myocardial infarction, composite microvascular complications, or retinopathy at a magnitude of 10%. Intensive glycaemic control increases the relative risk of severe hypoglycaemia by 30%.

This is actually quite important. It is very difficult for patients to maintain low levels of blood glucose, with consequences in both quality of life and adverse events. Tight glycemic control, for example is the reason that some policy makers have concerns about diabetics driving (due to worries about hypoglycemic attacks).

Given the difficulty of getting diabetics to adhere to tight glycemic control (and concerns about issues like driving), perhaps we should be more cautious in pushing tight control? More interestingly, we should ask why this association seems non-linear, as it is obvious that objectively poor glycemic control is very cardiotoxic.

But this was a very interesting paper for highlighting what we do and not not know.

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