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

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.

The Changing Landscape of Pharmacotherapy for Diabetes Mellitus: A Review of Cardiovascular Outcomes

The prevention of cardiovascular morbidity and mortality has always been a primary concern in patients with type 2 diabetes. Modern trials of glucose-lowering therapies now assess major adverse cardiac events as an endpoint in addition to the effects on glycaemic control. Whilst the data on the efficacy of intensive glucose lowering on reducing cardiovascular risk are limited, there are now increasing numbers of glucose-lowering therapies that have proven cardiovascular benefit independent of glucose lowering. This review will summarise the available literature on cardiovascular outcomes in relation to metformin, sulphonylureas, di-peptidyl peptidase-4 inhibitors, glucagon-like peptide receptor agonists, sodium-glucose co-transporter 2 inhibitors, thiazolidinediones, acarbose and insulin. In addition, new paradigms in diabetes management and the importance of treatment selection based on considerations including but not limited to glycaemic control will be discussed.