scholarly journals A target HbA1c between 7 – 7.7% reduces macrovascular events in T2D regardless of duration of diabetes – a meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Binayak Sinha ◽  
Samit Ghosal
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Diabetes Duration ◽  
Controlled Trials ◽  
Glucose Lowering ◽  
Intention To Treat ◽  
Fatal Stroke ◽  
Randomized Controlled ◽  
Intensive Glucose Lowering

ABSTRACTIntroductionThe target glycosylated haemoglobin (HbA1c) at which macrovascular benefits may be derived in type 2 diabetes (T2D) has never been clearly outlined. This meta-analysis was conducted on fifteen randomized controlled trials to highlight the association of HbA1c range with macrovascular events.MethodsThe association of different HbA1c clusters (intention to treat (ITT) and end-of-study [EOS]) range (less or equal than 6.5%, 6.6%–7.0%, 7.1%–7.7%) with macrovascular complications and also the combined effect of duration of T2D (< 10 years or ≥ 10 years) and HbA1c levels was assessed.ResultsIntensive glucose-lowering strategy resulted in a significant 13% reduction in non-fatal myocardial infarction (NFMI) (P=0.006). Based on HbA1c achieved, a significant 36% reduction in non-fatal stroke (P=0.008) and a 22% reduction in all-cause mortality (P=0.02) were observed in the group with HbA1c between 7.1% – 7.7% irrespective of diabetes duration. In the cohort, with diabetes duration <10 years, reduction of HbA1c in the range7.1% - 7.7% resulted in a significant 36% reduction in non-fatal stroke (NFS) (P<0.001).ConclusionThis is probably the first meta-analysis highlighting the importance of treating patients with T2D to a target HbA1C of 7 – 7.7%, as this target is associated with reduction in macrovascular events.

scholarly journals Effects of Canagliflozin on Fatty Liver Indexes in Patients with Type 2 Diabetes: A Meta-analysis of Randomized Controlled Trials

2018 ◽  
Vol 21 ◽  
pp. 222-235 ◽  
Author(s):  
Boyu Li ◽  
Ying Wang ◽  
Zhikang Ye ◽  
Hui Yang ◽  
Xiangli Cui ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Fatty Liver ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Glutamyl Transferase

PURPOSE: Non-alcoholic fatty liver disease (NAFLD) affects about 75% of patients with type 2 diabetes mellitus (T2DM). We conducted a meta-analysis to determine the effect of canagliflozin on fatty liver indexes in T2DM patients. METHODS: A literature search of PubMed, Embase and Cochrane was conducted up to March 30, 2017. The liver function test and lipid profile were extracted from randomized controlled trials (RCTs) to evaluate the effect of canagliflozin on fatty liver. Weighted mean differences (WMDs) or relative risks and 95% confidence intervals (CIs) were computed by using either fixed or random-effects models. Sensitivity analysis and publication bias were evaluated. RESULTS: Our results showed that canagliflozin decreased serum concentrations of  alanine amino transferase (WMD: -11.68 [95% CI: -18.95, -10.95]; P<0.001), aspartate amino transferase (WMD: -7.50 [95% CI: -10.61, -4.38]; P<0.001), gamma-glutamyl transferase (WMD: -15.17 [95% CI: -17.73, -12.61]; P<0.001), triglycerides (WMD: -0.10 [95% CI: -0.15, -0.05]; P<0.001) but increased low-density lipoprotein cholesterol (WMD: 0.1 [95% CI: 0.06, 0.13]; P<0.001), high-density lipoprotein cholesterol (WMD: 0.06 [95% CI: 0.05, 0.07]; P<0.001) at week 26 or 52. CONCLUSIONS: Our results indicated that canagliflozin may have a protective effect on fatty liver in T2DM patients. The limitation was that the liver biopsy was hard to obtain in published studies. More RCTs specified on NAFLD are needed to get further information. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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