Impact of specific glucose-control strategies on microvascular and macrovascular outcomes in 58,000 adults with type 2 diabetes

Neugebauer R, Fireman B, Roy JA, O’Connor PJ. Impact of specific glucose-control strategies on microvascular and macrovascular outcomes in 58,000 adults with type 2 diabetes. Diabetes Care. 2013;36:3510-3516.

This study assessed the impact of four glucose-control strategies on micro- and macrovascular outcomes in typical type 2 diabetes patients in primary care practices. The impact of treatment intensification at A1C ≥7%, ≥7.5%, ≥8%, or ≥8.5% on acute MI, onset or progression of albuminuria, and eGFR was examined. Subjects (N=58,671) had type 2 diabetes and A1C <7% while taking ≥2 oral antihyperglycemic drugs or basal insulin, followed by A1C ≥7% to 8.5%. Follow-up was date of first A1C ≥7% until specific macro- or microvascular event, death, disenrollment, or study end.  

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Type 2 Diabetes Treatment Intensification Based on A1C: Impact on Micro- and Macrovascular Complications   
Type 2 Diabetes Treatment Intensification
Based on A1C: Impact on Micro- and
Macrovascular Outcomes
 

Impact on acute MI
No significant differences in acute MI were seen in any treatment intensification group (A1C ≥7%, ≥7.5%, ≥8%, or ≥8.5%). A trend toward fewer acute MI was seen with intensification at A1C ≥7% vs ≥8.5% (P=0.08) or ≥8% vs ≥8.5% (P=0.05). Acute MI occurred among 2.8% (n=1,655) of 58,671 subjects over median follow-up of ~3.25 years. Median time to treatment intensification was ~1.5 years; 41.1% (n=24,127) intensified treatment.
 

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Type 2 Diabetes Treatment Intensification Based on A1C: Impact on Acute MI   
Type 2 Diabetes Treatment Intensification
Based on A1C: Impact on Acute MI
 

Impact on onset or progression of albuminuria
There was a lower likelihood of onset or progression of albuminuria when treatment was intensified at A1C ≥7% (P=0.02), ≥7.5% (P=0.04), ≥8% (P=0.01) vs ≥8.5%. No benefits were seen with treatment intensification at

  • A1C ≥7% vs ≥7.5% (P=0.035)
  • A1C ≥7.5% vs ≥8% (P=0.73)
  • A1C ≥7% vs ≥8% (P=0.27)

Onset or progression of albuminuria occurred among 23.6% (n=12,085) of 51,179 subjects* over median follow-up of ~2.5 years. Median time to treatment intensification was ~1.25 years; 34.4% (n=17,581) intensified treatment.  

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Type 2 Diabetes Treatment Intensification Based on A1C: Impact on Onset or Progression of Albuminuria   
Type 2 Diabetes Treatment Intensification
Based on A1C: Impact on Onset or Progression
of Albuminuria
 

Impact on eGFR
There was a higher likelihood of decline in renal function when treatment was intensified at A1C ≥7% vs ≥8% (P=0.04) or ≥8.5% (P=0.18), but not at ≥7.5% (P=0.18). Decreased eGFR occurred among 44.8% (n=25,930) of 57,927 subjects over median follow-up ~1.75 years. Median time to treatment intensification was ~1 year; 28.32% (n=16,405) intensified treatment. 

Click on slide thumbnail to view larger. Slide available for download in the slide library.
Type 2 Diabetes Treatment Intensification Based on A1C: Impact on eGFR   
Type 2 Diabetes Treatment Intensification
Based on A1C: Impact on eGFR
 


*Patients missing baseline urine albumin-to-creatinine ratio and patients with macroalbuminuria (n=7,492 of 58,671 in overall study population) were excluded from the albuminuria analysis.
Patients missing baseline eGFR and patients with baseline eGFR <15 mL/min/1.72 m2 (n=744 of 58,671 in overall study population) were excluded from the eGFR analysis.

eGFR=estimated glomerular filtration rate; MI=myocardial infarction
 

  

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States. 

May 2014 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

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Last Modified: 8/5/2014