“Scant Evidence That Tight Glycemic Control Helps In Type 2 Diabetes”

The following article is on Internal Medicine – Medscape – News and Perspective:    Reuters Health Information Scant Evidence That Tight Glucose Control Is Helpful in T2DM By Anne Harding August 24, 2016 and is based on the article in Resources:

What follows is from the above article:

NEW YORK (Reuters Health) – Despite guidelines that confidently recommend tight glucose control for preventing complications of type 2 diabetes, there is little evidence that this approach helps patients, according to the authors of a new review.

“The evidence that we have for glycemic control in patients with type 2 diabetes is not very clear in terms of connecting glycemic control with improved risk of diabetes complications,” Dr. Victor Montori, a professor at the Mayo Clinic in Rochester, Minnesota, and advisor to the Agency for Healthcare Research and Quality, told Reuters Health in a telephone interview.

But “our experts have not been telling us that,” Dr. Montori added. Instead, he said, experts are claiming there is clear evidence that tight glycemic control reduces the risk of microvascular complications, and “less clear but also compelling” evidence that it helps prevent heart attack and stroke.

“That is obviously not consistent with the clarity of the evidence,” he said.

Dr. Montori and his Mayo Clinic colleague Dr. Rene Rodriguez-Gutierrez analyzed 16 guidelines, 328 journal articles, 11 meta-analyses published from 2009 to 2014, and five randomized controlled trials along with extension studies and published their findings online August 23 in Circulation: Cardiovascular Quality Outcomes.

Overall, they found, the evidence warranted “moderate confidence,” and showed no significant benefit of tight glucose control for the risk of dialysis, kidney transplant, renal death, blindness, or neuropathy. Nevertheless, 77% to 100% of published statements and 95% of the guidelines “unequivocally endorsed benefit” of tight glucose control for preventing microvascular complications.

The investigators also found no evidence for a significant effect of tight glucose control on all-cause mortality, cardiovascular mortality, or stroke, while they did find a consistent 15% reduction in relative risk for non-fatal myocardial infarction (MI). From 2006-2008 most statements backed the benefits of tight glucose control for reducing macrovascular complications. But after the 2008 ACCORD trial, which found tight glycemic control actually increased the risk of all-cause mortality by 26% and the risk of cardiovascular mortality by 43%, a minority of statements continued to claim macrovascular benefits for the approach.

Resources:

Glycemic Control for Patients With Type 2 Diabetes Mellitus: Our Evolving Faith in the Face of Evidence [PubMed Abstract]
René Rodríguez-Gutiérrez and Victor M. Montori
Circ Cardiovasc Qual Outcomes 2016; first published on August 23 2016 as doi:10.1161/CIRCOUTCOMES.116.002901

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