In people with type 2 diabetes, intensive treatment that aims to lower blood sugar levels reduces nonfatal heart attacks and doesn’t increase deaths

Seidu S, Achana FA, Gray LJ, et al. Effects of glucose-lowering and multifactorial interventions on cardiovascular and mortality outcomes: a meta-analysis of randomized control trials. Diabet Med. 2016;33:280-9.

Review question

In people with type 2 diabetes, does intensive drug treatment that aims to lower blood sugar levels affect risks for death, heart attack, or stroke?

Background

Type 2 diabetes is a disease that increases blood sugar levels. High blood sugar levels over a long period of time can increase your risk of getting heart disease or having a heart attack or stroke. Some people with type 2 diabetes can control their blood sugar levels through exercise and diet. Many people will also need to use drugs to help manage their diabetes. Intensive treatment, which often includes higher drug doses or more than one drug, may better control blood sugar levels in some people. We need to know whether intensive treatment lowers risks for death, heart disease, or stroke.

The research

19 studies (randomized controlled trials) that were published up to May 2015.

The studies included 84,460 adults with type 2 diabetes. People were, on average, 52 to 69 years of age. 29% to 100% were men.

Studies compared an intensive treatment with a control group (placebo, standard care, or a less-intensive treatment). Most studies assessed intensive treatment that only aimed to lower blood sugar levels. Some studies assessed a multicomponent intensive treatment regimen that aimed to control blood pressure or cholesterol as well as blood sugar levels.

What the researchers found

Compared with control, intensive drug treatment to lower blood sugar levels (with or without treatment to lower blood pressure or cholesterol levels):

• reduced nonfatal heart attacks; and
• did not increase or decrease nonfatal strokes, death from heart or circulation problems, or death from any cause.

Compared with control, multicomponent intensive treatments that aimed to lower blood pressure or cholesterol as well as blood sugar levels reduced nonfatal strokes.

Conclusion

In people with type 2 diabetes, intensive drug treatment to lower blood sugar levels reduced heart attacks; when combined with treatments to lower blood pressure and cholesterol, stroke was reduced as well.

Intensive treatment* vs control (placebo, standard care, or a less-intensive treatment) to lower blood sugar levels in people with type 2 diabetes

*Most studies assessed intensive drug treatment that aimed to lower only blood sugar levels. Some studies assessed intensive treatment with multiple components that aimed to control blood pressure or cholesterol levels as well as blood sugar levels. Results for both types of treatment were similar unless noted otherwise.

†People who also received intensive treatment for high blood pressure and high cholesterol had fewer strokes than those who received a control treatment.