The association between intensive glycemic control and vascular complications in type 2 diabetes mellitus: A meta-analysis

Abstract

Background and Aim In patients with type 2 diabetes mellitus, the relationship between lowering glycated hemoglobin (HbA 1c) and macrovascular complications is not clear and therefore lowering the level of HbA 1c is controversial. Methods and Results We searched for all randomized controlled trials comparing the effects of intensive and standard glycemic control on vascular events in patients with type 2 diabetes mellitus. The primary endpoint was combined macrovascular complications, including cardiac events, stroke and peripheral vascular disease. Fixed and random effect models were used to analyze the results. Eight studies were included according to selection criteria. The results showed no benefits of intensive glycemic control on macrovascular and microvascular complications ( P > 0.1), but a higher rate of severe hypoglycemia ( P < 0.00001) in the intensive control group when the target HbA 1c level was <7.0%. When the target HbA 1c level was lowered to 7.0–7.9%, intensive glycemic control showed benefits on the reduction of microvascular events ( P < 0.05) without increasing the risk of severe hypoglycemia ( P = 0.74), but no influence on macrovascular complications ( P > 0.1). Conclusion The results of this analysis suggest that a target HbA 1c level of 7.0–7.9% may be a better glycemic control target than that of <7.0% in patients with established type 2 diabetes mellitus.