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    Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes:

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    graham64
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    Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes:

    Post by graham64 on Mon Apr 03 2017, 22:26

    Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes: a meta-analysis of individual participant data from randomised controlled trials

    Summary

    Background
    Intensive glucose control is understood to prevent complications in adults with type 2 diabetes. We aimed to more precisely estimate the effects of more intensive glucose control, compared with less intensive glucose control, on the risk of microvascular events.

    Methods
    In this meta-analysis, we obtained de-identified individual participant data from large-scale randomised controlled trials assessing the effects of more intensive glucose control versus less intensive glucose control in adults with type 2 diabetes, with at least 1000 patient-years of follow-up in each treatment group and a minimum of 2 years average follow-up on randomised treatment. The prespecified and standardised primary outcomes were kidney events (a composite of end-stage kidney disease, renal death, development of an estimated glomerular filtration rate <30 mL/min per 1·73m2, or development of overt diabetic nephropathy), eye events (a composite of requirement for retinal photocoagulation therapy or vitrectomy, development of proliferative retinopathy, or progression of diabetic retinopathy), and nerve events (a composite of new loss of vibratory sensation, ankle reflexes, or light touch). We used a random-effects model to calculate overall estimates of effect.


    Findings
    We included four trials (ACCORD, ADVANCE, UKPDS, and VADT) with 27 049 participants. 1626 kidney events, 795 eye events, and 7598 nerve events were recorded during the follow-up period (median 5·0 years, IQR 4·5–5·0). Compared with less intensive glucose control, more intensive glucose control resulted in an absolute difference of −0·90% (95% CI −1·22 to −0·58) in mean HbA1c at completion of follow-up. The relative risk was reduced by 20% for kidney events (hazard ratio 0·80, 95% CI 0·72 to 0·88; p<0·0001) and by 13% for eye events (0·87, 0·76 to 1·00; p=0·04), but was not reduced for nerve events (0·98, 0·87 to 1·09; p=0·68).

    Interpretation
    More intensive glucose control over 5 years reduced both kidney and eye events. Glucose lowering remains important for the prevention of long-term microvascular complications in adults with type 2 diabetes.

    Funding

    None.

    http://www.thelancet.com/journals/landia/article/PIIS2213-8587(17)30104-3/


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    chris c
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    Re: Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes:

    Post by chris c on Mon Apr 03 2017, 23:33

    Another sodding paywalled paper! <sigh>

    I wonder if Peter Reaven is related to the great Gerald.

    "Compared with less intensive glucose control, more intensive glucose control resulted in an absolute difference of −0·90% (95% CI −1·22 to −0·58) in mean HbA1c at completion of follow-up."

    Yeah well they didn't do a very good job did they? ACCORD and the VADT I think both used heroic amounts of medication on top of high carb diets, and ACCORD was notorious for finding CVD risk increased with "intensive" treatment.

    Someone on Ivor Cummins' Twitter feed kindly dug this up

    http://diabetes.diabetesjournals.org/content/55/6/1807

    which shows what occurred - different pathways are affected by hyperglycemia and hyperinsulinemia, so using excess insulin to reduce BG turns down one pathway and turns up the other (this predates both I think - 2006)

    LCHF turns down both pathways to destruction.

      Current date/time is Wed Oct 24 2018, 06:44