Research Article
Volume 5 Issue 1 - 2021
The Impact of Intensive Versus Standard Control of Glycemia on the Risk of Poor Kidney Outcomes and Mortality in Patients with Type 2 Diabetes: A Meta-Analysis of Randomized Studies
Doaa Mohammed Shaaban Mohammed1*, Ibrahim Abdraboh Alhazmi2, Nalah Yahya Al-Mani2, Abdulrahman Mohammed Al-Sawidan2, Jumanah Ali Bafail3, Norah Hussain Alameri4, Aisha Abutaleb Alhassani4, Hanan Ibrahim Alhassani4, Hisham Mohmed Abdullah AlHindi5 and Wafa Adel Toonsi3
1General Practitioner, Ministry of Interior, Jeddah, Saudi Arabia
2Medical Intern, College of Medicine, Najran University, Najran, Saudi Arabia
3Medical Intern, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
4Medical Intern, College of Medicine, Umm al-Qura University, Al-Qunfudhah, Saudi Arabia
5Resident Internal Medicine, Ministry of Health, King Abdulaziz Hospital, Jeddah, Saudi Arabia
*Corresponding Author: Doaa Mohammed Shaaban Mohammed, General Practitioner, Ministry of Interior, Jeddah, Saudi Arabia.
Received: December 20, 2020; Published: December 31, 2020




Abstract

Background: The impact of targeting intensive glycemic control on the risk of developing renal complications in type 2 diabetes (T2DM) is controversial and an updated evidence is required from randomized clinical trials (RCTs).

Objectives: To conduct a meta-analysis of the effects of intensive versus standard glycemic control interventions on the risk of developing renal complications and death in T2DM.

Methods: Three scientific databases were searched for eligible RCTs and their updated post-hoc analyses to identify the impact of intensive glycemic control on the risk of incident microalbuminuria (MA) and doubling of serum creatinine (primary outcomes) as well as macroalbuminuria, ESRD, renal death and all-cause mortality (secondary outcomes). Pooled effect estimates and 95% confidence intervals (95% CIs) were computed based on risk ratios (RRs) and time-to-event data (hazard ratios [HRs]).

Results: A total of 13 articles (corresponding to eight RCTs) were included (31,111 patients, 61.23% males). The risks of MA, doubling of serum creatinine, ESRD, death from kidney disease, and all-cause mortality were not changed by intensive glucose control. However, the risk of macroalbuminuria decreased with the tight control compared to standard interventions (RR = 0.73, 95%CI, 0.66 to 0.80, p < 0.001 and HR = 0.71, 95%CI, 0.61 to 0.81, p < 0.001). Performance bias was evident in six trials (75%).

Conclusion: There was a 27% reduced risk of macroalbuminuria with intensive glucose control despite the lack of effects on other clinically meaningful outcomes of overt nephropathy. Future randomized studies should report renal outcomes based on large sample sizes, long-term follow-up periods, and using novel and reliable biomarkers of nephropathy.

Keywords: Diabetes Mellitus; Blood Glucose; HbA1c; Randomized Clinical Trials

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Citation: Doaa Mohammed Shaaban Mohammed., et al. ““The Impact of Intensive Versus Standard Control of Glycemia on the Risk of Poor Kidney Outcomes and Mortality in Patients with Type 2 Diabetes: A Meta-Analysis of Randomized Studies”. EC Diabetes and Metabolic Research 5.1 (2021): 03-16.

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