Glycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: Meta-analysis of randomized trials

Stettler, Christoph; Allemann, Sabin; Jüni, Peter; Cull, C A; Holman, Rury R.; Egger, Matthias; Krähenbühl, Stephan; Diem, Peter

doi:10.1016/j.ahj.2005.09.015

Cited by 422 publications

(278 citation statements)

References 38 publications

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“…This assertion, based on the observation that the only strong epidemiological glycaemia-CAD link was in the Lehto et al study [6] of participants without renal disease, is also consistent with the DCCT/EDIC trial data. In DCCT/EDIC, a reduction in the risk of CVD events in the intensive insulin therapy group was reported, where both a fall in HbA 1c occurred and renal disease was less apparent [13]. The present EDC analyses also suggest that change in glycaemia is a predictor even when baseline or mean HbA 1c during follow-up is not.…”

Section: Discussionsupporting

confidence: 57%

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Changes in glycaemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC)

et al. 2007

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Aims/hypothesis To complete a comparative analysis of studies that have examined the relationship between glycaemia and cardiovascular disease (CVD)/coronary artery disease (CAD) and perform a prospective analysis of the effect of change in glycosylated Hb level on CAD risk in the Pittsburgh Epidemiology of Diabetes Complications Study (EDC) of childhood-onset type 1 diabetes mellitus (n=469) over 16 years of two yearly follow-up.Methods Measured values for HbA 1 and HbA 1c from the EDC were converted to the DCCT-standard HbA 1c for change analyses and the change in HbA 1c was calculated (final HbA 1c minus baseline HbA 1c ). CAD was defined as EDC-diagnosed angina, myocardial infarction, ischaemia, revascularisation or fatal CAD after medical record review. Results The comparative analysis suggested that glycaemia may have a stronger effect on CAD in patients without, than in those with, albuminuria. In EDC, the change in HbA 1c differed significantly between CAD cases (+0.62± 1.8%) and non-cases (−0.09±1.9%) and was an independent predictor of CAD. Conclusions/interpretation Discrepant study results regarding the relationship of glycaemia with CVD/CAD may, in part, be related to the prevalence of renal disease. Measures of HbA 1c change over time show a stronger association with CAD than baseline values.

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Section: Discussionsupporting

confidence: 57%

“…In contrast, a recent meta-analysis of clinical trials by Stettler et al found that improved glycaemic control reduces the incidence of CAD and CVD in type 1 as well as type 2 diabetes, although the effect was less marked in type 2 [13]. A large portion of the type 1 population in the meta-analysis comprised the DCCT study population.…”

Section: Introductionmentioning

confidence: 87%

Changes in glycaemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC)

et al. 2007

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“…Therefore, a role for hyperglycaemia itself emerges forcefully. The benefit of improved metabolic control on vascular complications is typically smaller than expected [3], suggesting that other non-traditional, diabetesrelated risk factors are involved and/or that glycaemic control is generally insufficient. Experimental evidence indicates that atherogenic mechanisms, such as endothelial dysfunction, oxidative stress and inflammation, may be chronically activated in diabetes [4][5][6][7], at least in part as a consequence of exaggerated postprandial glucose excursions [8][9][10].…”

Section: Introductionmentioning

confidence: 95%

Effects of glucose tolerance on the changes provoked by glucose ingestion in microvascular function

et al. 2008

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Aims/hypothesis Hyperglycaemia and hyperinsulinaemia have opposite effects on endothelium-dependent vasodilatation in microcirculation, but the net effect elicited by glucose ingestion and the separate influence of glucose tolerance are unknown. Methods In participants with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) or diabetic glucose tolerance, multiple plasma markers of both oxidative stress and endothelial activation, and forearm vascular responses (plethysmography) to intra-arterial acetylcholine (ACh) and sodium nitroprusside (SNP) infusions were measured before and after glucose ingestion. In another IGT group, we evaluated the time-course of the skin vascular responses (laser Doppler) to ACh and SNP (by iontophoresis) 1, 2 and 3 h into the OGTT; the plasma glucose profile was then reproduced by means of a variable intravenous glucose infusion and the vascular measurements repeated. Results Following oral glucose, plasma antioxidants were reduced by 5% to 10% (p<0.01) in all patient groups. The response to acetylcholine was not affected by glucose ingestion in any group, while the response to SNP was attenuated, particularly in the IGT group. The ACh:SNP ratio was slightly improved therefore in all groups, even in diabetic participants, in whom it was impaired basally. A time-dependent improvement in ACh:SNP ratio was also observed in skin microcirculation following oral glucose; this improvement was blunted when matched hyperglycaemia was coupled with lower hyperinsulinaemia (intravenous glucose). Conclusions/interpretation Regardless of glucose tolerance, oral glucose does not impair endothelium-dependent vasodilatation either in resistance arteries or in the microcirculation, despite causing increased oxidative stress; the endogenous insulin response is probably responsible for countering any inhibitory effect on vascular function.

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“…Glycaemic control has been shown to be related to macrovascular complications [47,48], and was, therefore, included in the present analysis. Importantly, information on glycaemic control had to be based on fasting glucose, since HbA 1c was not available at the time of study entry, thereby potentially limiting the accuracy of adjustment.…”

Section: Qtc Intervalmentioning

confidence: 99%

QTc interval and resting heart rate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus: a 23-year follow-up

et al. 2006

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Aims/hypothesis We evaluated the association of QT interval corrected for heart rate (QT c ) and resting heart rate (rHR) with mortality (all-causes, cardiovascular, cardiac, and ischaemic heart disease) in subjects with type 1 and type 2 diabetes. Methods We followed 523 diabetic patients (221 with type 1 diabetes, 302 with type 2 diabetes) who were recruited between 1974 and 1977 in Switzerland for the WHO Multinational Study of Vascular Disease in Diabetes. Duration of follow-up was 22.6±0.6 years. Causes of death were obtained from death certificates, hospital records, post-mortem reports, and additional information given by treating physicians.

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Glycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: Meta-analysis of randomized trials

Cited by 422 publications

References 38 publications

Changes in glycaemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC)

Changes in glycaemic control and risk of coronary artery disease in type 1 diabetes mellitus: findings from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC)

Effects of glucose tolerance on the changes provoked by glucose ingestion in microvascular function

QTc interval and resting heart rate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus: a 23-year follow-up

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