Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes
| Autor: | Sern Lim, Philip Böhme, Michel Marre, David Hopkins, Paul Glasziou, Alice Stanton, Severine Bompoint, John Chalmers, Christopher J Nolan, Basel Al Aloul, Nikolai Petrovsky, Simon Heller, Rohina Joshi, Peter Minárik, Karen R Mullan, Gillian Whalley, Andre Pascal Kengne, Beata Czerwieńska, Mark Woodward, Bryan Williams, Ronald Stolk, Rafał Ficek, Vivek Chaturvedi, Bruce Neal, Hapizah Nawawi, Stephen Harrap, Stephen MacMahon, Dorairaj Prabhakaran, Steve Aldington, Anushka Patel, Anthony Rodgers, Laurent Billot, Lakshmy Ramakrishnan |
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| Přispěvatelé: | Groningen Kidney Center (GKC), Translational Immunology Groningen (TRIGR) |
| Jazyk: | angličtina |
| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Diabetic Nephropathies/epidemiology Health aging / healthy living [IGMD 5] 030209 endocrinology & metabolism Vascular medicine and diabetes [UMCN 2.2] Type 2 diabetes 030204 cardiovascular system & hematology Diabetic angiopathy Hypoglycemia Hypoglycemia/chemically induced Nephropathy Glycated Hemoglobin A/analysis 03 medical and health sciences chemistry.chemical_compound Diabetic Angiopathies/epidemiology 0302 clinical medicine Drug Therapy Risk Factors Internal medicine Diabetes mellitus Diabetes Mellitus medicine Humans Type 2/blood Aged Proportional Hazards Models Proportional hazards model business.industry Gliclazide/administration & dosage Cardiovascular Diseases/epidemiology Hazard ratio General Medicine Blood Glucose/analysis Middle Aged medicine.disease Hypoglycemic Agents/administration & dosage 3. Good health Surgery chemistry Combination Cardiology Drug Therapy Combination Female Glycated hemoglobin business Diabetes Mellitus Type 2/blood Follow-Up Studies |
| Zdroj: | New England Journal of Medicine, 358(24), 2560-2572. MASSACHUSETTS MEDICAL SOC The New England Journal of Medicine, 358, 24, pp. 2560-72 The New England Journal of Medicine, 358, 2560-72 |
| ISSN: | 0028-4793 |
| Popis: | Contains fulltext : 69678.pdf (Publisher’s version ) (Open Access) BACKGROUND: In patients with type 2 diabetes, the effects of intensive glucose control on vascular outcomes remain uncertain. METHODS: We randomly assigned 11,140 patients with type 2 diabetes to undergo either standard glucose control or intensive glucose control, defined as the use of gliclazide (modified release) plus other drugs as required to achieve a glycated hemoglobin value of 6.5% or less. Primary end points were composites of major macrovascular events (death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke) and major microvascular events (new or worsening nephropathy or retinopathy), assessed both jointly and separately. RESULTS: After a median of 5 years of follow-up, the mean glycated hemoglobin level was lower in the intensive-control group (6.5%) than in the standard-control group (7.3%). Intensive control reduced the incidence of combined major macrovascular and microvascular events (18.1%, vs. 20.0% with standard control; hazard ratio, 0.90; 95% confidence interval [CI], 0.82 to 0.98; P=0.01), as well as that of major microvascular events (9.4% vs. 10.9%; hazard ratio, 0.86; 95% CI, 0.77 to 0.97; P=0.01), primarily because of a reduction in the incidence of nephropathy (4.1% vs. 5.2%; hazard ratio, 0.79; 95% CI, 0.66 to 0.93; P=0.006), with no significant effect on retinopathy (P=0.50). There were no significant effects of the type of glucose control on major macrovascular events (hazard ratio with intensive control, 0.94; 95% CI, 0.84 to 1.06; P=0.32), death from cardiovascular causes (hazard ratio with intensive control, 0.88; 95% CI, 0.74 to 1.04; P=0.12), or death from any cause (hazard ratio with intensive control, 0.93; 95% CI, 0.83 to 1.06; P=0.28). Severe hypoglycemia, although uncommon, was more common in the intensive-control group (2.7%, vs. 1.5% in the standard-control group; hazard ratio, 1.86; 95% CI, 1.42 to 2.40; P |
| Databáze: | OpenAIRE |
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