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Abstract
Background:
The idea of intensive glycemic control as an intervention to minimize the risk of microvascular and macrovascular complications has been suggested in patients with type 2 diabetes mellitus (T2DM). Nevertheless, there is still inconsistent evidence concerning its usefulness, especially when it comes to long-term results and whether it can be applied to the Middle Eastern populations.
Objective:
To assess the effect of intensive glucose control on microvascular and macrovascular complications in those with T2DM and its relevance to the Middle East and United Arab Emirates (UAE).
Methods:
The systematic review and meta-analysis were carried out as per PRISMA 2020 guidelines. An extensive literature review was used to find original research on intensive versus standard glycemic control in adults with T2DM. Included were 11 studies and 6 reports from 4 randomized controlled trials (ACCORD, ADVANCE, VADT, and UKPDS), which were suitable for quantitative pooling. Results with comparable effect measures were pooled using a random-effects model were grouped into meta-analysis using random effects. The I² statistic was used to determine heterogeneity, and results that could not be pooled were synthesized using narrative.
Results:
The small and near-significant decrease in major macrovascular events was observed with intensive glycemic control (HR 0.91; 95% CI 0.84-0.99; I² = 0). There was no impact on overall mortality (HR 1.05; 95% CI 0.88-1.27; I² = 66.3%) with the heterogeneity being driven by greater mortality in the ACCORD trial. A modest benefit was observed for overall microvascular outcomes (HR 0.90; 95% CI 0.82–1.00; I² = 30.2%). The most significant effect was the decrease in the nephropathy outcomes (HR 0.75; 95% CI 0.66-0.85; I² = 0%). There was an inconsistent effect on retinopathy and neuropathy. The long-term results were not consistent, as there was a legacy effect in UKPDS and no long-term benefit in ADVANCE-ON.
Conclusion:
Intensive glycemic control in T2DM offers limited benefits in decreasing microvascular disease, especially nephropathy, but has no significant effect on macrovascular disease or death. The results suggest personalized glycemic goals, as opposed to standardized intensive control interventions, particularly in heterogeneous populations like Middle East and UAE.