Navigation Links
Benefit of blood glucose lowering to near-normal levels remains unclear

Whether patients with type 2 diabetes mellitus benefit from attempts to lower their blood glucose levels to near-normal levels through treatment ("intensive blood glucose control") remains an unanswered question. The studies currently available provide indications of a benefit but also of potential harm. This is the result of a report published by the German Institute for Quality and Efficiency in Health Care (IQWiG).

Epidemiological studies have shown that the risk of vascular disease or death rises with increasing blood glucose levels in people with type 2 diabetes. In order to prevent late complications of diabetes, clinical practice guidelines therefore recommend lowering blood glucose levels to a "near-normal" range. This refers to levels close to those of people without diabetes. In the report now presented (a rapid report), IQWiG investigated whether this treatment strategy, i.e. a strategy aiming to achieve (nearly) normal blood glucose levels, also actually reduces the risk of late complications of diabetes.

Comparison of two treatment strategies

For this purpose IQWiG searched for randomized controlled trials comparing two treatment strategies in patients with type 2 diabetes. In the test group the measures were aimed at long-term lowering of blood glucose to near-normal levels. In the control group there was no such aim or the measure applied was not so intensive. In this context, the main criteria for assessing the benefit or harm of the interventions were mortality (all-cause mortality), late complications of diabetes (heart attacks, strokes, damage to the kidneys or eyes etc.), as well as quality of life.

Three studies conducted after 2000

Overall, IQWiG included seven studies, in which a total of 28,000 patients had participated, in the assessment. The studies differed quite considerably: four studies had already been conducted between the 1960s and 1990s, the others after the year 2000. They partly included patients of a specific ethnic origin (Japan) and in some studies drugs were widely applied that are no longer on the market (rosiglitazone).

IQWiG finds no differences for important treatment outcomes

In the analysis of the studies, IQWiG found no differences between the two groups for relevant aspects of treatment. Proof or indications that one of the two treatment strategies offered more advantages or disadvantages were found neither for all-cause mortality nor for fatal heart attacks, (fatal and non-fatal) strokes, end-stage renal disease (and its pre-stages), amputations, or pre-stages of blindness. Insufficient data were available for the outcomes "quality of life" and "blindness".

Indications that patients with type 2 diabetes benefit from intensive blood glucose control were found only for the outcome "non-fatal heart attacks". However, at the same time the data provide indications that severe hypoglycaemic episodes as well as other serious events in part occurred considerably more often in the intensive-therapy group than in the group with less intensive lowering of blood glucose levels.

Overall, the results of the current IQWiG report are consistent with those of reviews and meta-analyses recently conducted and presented by other researchers.

Question as to which treatment strategy is better still remains unanswered

The IQWiG Director Jrgen Windeler comments on the current report: "It is quite astonishing: individual interventions, particularly drugs, have in part been well investigated in studies; however, we know relatively little about the advantages and disadvantages of treatment strategies. If doctors are faced with the question as to what they can specifically offer to their diabetes patients, whether they should lower blood glucose levels as much as possible, and in which patients this a promising (or less promising) approach, they still do not receive satisfactory answers." Even though this is a key question in the care of people with type 2 diabetes, the few studies available do not allow reliable conclusions.


Contact: IQWiG
Institute for Quality and Efficiency in Health Care

Related medicine news :

1. Cancer patients with blood clots gain no benefit from adding IVCF to fondaparinux
2. Leeds researchers test benefit of fish oil in bowel cancer spread
3. Longest Trial Ever Confirms Mammograms Benefits
4. Study shows long-term benefits of breast screening
5. Religion benefits traumatic brain injury victims, Wayne State University research finds
6. Alcohol drinking in the elderly: Risks and benefits
7. Athletes May Benefit From Shorter, Less Intense Warm-Ups
8. Study of phytoremediation benefits of 86 indoor plants published
9. CDC Cites Benefits of Expanded HIV Testing Program
10. Pacemaker implantation for heart failure does not benefit nearly half of the patients
11. Certain head and neck cancer patients benefit from second round of treatment
Post Your Comments:
(Date:6/26/2016)... ... June 27, 2016 , ... Quality metrics are proliferating in cancer care, and ... in the eye of the beholder, according to experts who offered insights and commentary ... of Managed Care. For the full issue, click here . , For the ...
(Date:6/26/2016)... North Carolina (PRWEB) , ... June 26, 2016 , ... ... release of a new product that was developed to enhance the health of felines. ... for centuries. , The two main herbs in the PawPaws Cat Kidney Support ...
(Date:6/25/2016)... ... June 25, 2016 , ... Experts ... applications at AcademyHealth’s Annual Research Meeting June 26-28, 2016, at the Hynes Convention ... health care topics including advance care planning, healthcare costs and patient and family ...
(Date:6/25/2016)... , ... June 25, 2016 , ... "With 30 hand-drawn ... specific project," said Christina Austin - CEO of Pixel Film Studios. , ProHand ... all within Final Cut Pro X . Simply select a ProHand generator and ...
(Date:6/25/2016)... ... June 25, 2016 , ... Dr. ... from injury. Recently, he has implemented orthobiologic procedures as a method for treating ... one of the first doctors to perform the treatment. Orthobiologics are substances that ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... , June 24, 2016  Consumers have taken ... regulators/payers have placed more emphasis on patient outcomes. ... support programs in the pharmaceutical industry have evolved ... Consequently, pharmaceutical companies are focusing on becoming more ... providing products and services that improve health. ...
(Date:6/24/2016)... June 24, 2016 ... announced the addition of the " Global Markets ... This report focuses ... an updated review, including its applications in various applications. ... market, which includes three main industries: pharmaceutical and biotechnology, ...
(Date:6/24/2016)... , June 24, 2016  American Respiratory Labs (ARL), a ... now able to perform sophisticated lung assessments in patients, homes, thanks ... Inc. Patients are no longer limited to having ... PRO ® , ARL patients like Jeanne R. of ... the comfort of her own home. ...
Breaking Medicine Technology: