Early intensive glycemic control reduces long-term risk of death and myocardial infarction in patients with type 2 diabetes

1. Sulfonylurea, insulin therapy, and metformin resulted in a significant relative risk reduction for all-cause mortality and myocardial infarction.

2. There were no significant differences in the risk for stroke or microvascular disease between groups.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The 20-year UK Prospective Diabetes Study demonstrated significant benefits for individuals with newly diagnosed type 2 diabetes who received intensive glycemic control compared to conventional control. A 10-year post-trial follow-up identified lasting benefits from glycemic and metformin treatments. This randomized controlled trial aimed to determine whether these benefits would persist over an additional 14 years. The primary outcome of this study was the incidence of death from any cause, while key secondary outcome was the incidence of myocardial infarction. According to study results, early intensive glycemic control continued to provide significant risk reductions for all-cause mortality and myocardial infarction up to 24 years following the end of the trial. Although this study was well done, it was limited by the reliance on routinely collected NHS data, which may not capture all relevant clinical outcomes.

Click to read the study in The Lancet

Relevant Reading: Glycemia Reduction in Type 2 Diabetes — Glycemic Outcomes

In-depth [randomized controlled trial]: Between 1977 and 1991, 5102 patients were screened for eligibility of which 1489 were ultimately included in the final analysis for the 14-year post-trial monitoring study. Included were patients with newly diagnosed type 2 diabetes (T2DM) who were assigned to either intensive glycaemic control or conventional glycaemic control. The primary outcome of all-cause mortality showed a 10% relative risk reduction (95% confidence interval [CI] 2-17, p=0.015) in the sulfonylurea or insulin therapy group compared to control. Risk reductions for myocardial infarction (MI) and microvascular disease with sulfonylurea or insulin were 17% (p=0.002) and 26% (p<0.0001), respectively. A similar trend was noted for metformin, which resulted in an overall risk reduction of 20% (95% CI 5-32, p=0.010) for all-cause mortality and 31% (95% CI 12-46, p=0.003) for MI. Overall, findings from this study suggest that early intensive glycemic control provides long-lasting benefits in reducing the risk of death and myocardial infarction in patients with type 2 diabetes.

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