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Title: Effects of intensive interventions compared to standard care in people with type 2 diabetes and microalbuminuria on risk factors control and cardiovascular outcomes: A systematic review and meta-analysis of randomised controlled trials.
Authors: Usman, Muhammad
Gillies, Clare L.
Khunti, Kamlesh
Davies, Melanie J.
First Published: 9-Oct-2018
Publisher: Elsevier for International Diabetes Federation
Citation: Diabetes Research and Clinical Practice, 2018, 146, pp. 76-84
Abstract: AIMS: The effect of intensive glycaemic control, blood pressure control and lipid levels control alone or as part of a multifactorial intervention has not been fully evaluated. We aimed to estimate the effects of more intensive interventions, compared with standard care, on risk factor control and cardiovascular outcomes in people with type 2 diabetes and microalbuminuria. METHODS: We searched MEDLINE, Embase and the Cochrane library without language restrictions from inception to August 10, 2018. We included randomised controlled trials that evaluated intensive interventions in adults with type 2 diabetes and microalbuminuria. The review was registered on PROSPERO (registration number 42017055208). We used random effects meta-analysis to calculate overall pooled effect estimates across studies. RESULTS: A total of seven (n = 1210) randomised controlled trials were included, four studies (n = 758) reported HbA1c, six studies (n = 950) reported blood pressure measurements, and three studies (n = 896) examined non-fatal MI, non-fatal stroke, cardiovascular mortality, and all-cause mortality. Intensive interventions indicated statistically significant reductions in both systolic and diastolic blood pressure, and a nonsignificant trend for reduction in HbA1c, total cholesterol, LDL, triglycerides and urinary albumin excretion rate. There was no evidence to suggest that compared with standard care, intensive interventions reduced the risk of non-fatal MI [risk ratio (RR) 0·50; 95% CI 0·20, 1·22; P = 0·127], non-fatal stroke (RR 0·44; 95% CI 0·10, 1·91; P = 0·275), CV mortality (RR 0·95; 95% CI 0·48, 1·86; P = 0·874) or all-cause mortality (RR 0·80; 95% CI 0·51, 1·25; P = 0·324). CONCLUSIONS: Apart from blood pressure outcomes, there was no evidence that intensive interventions improve or worsen HbA1c, total cholesterol, LDL, triglycerides, urinary albumin excretion rate, risk of cardiovascular or mortality outcomes in people with type 2 diabetes and microalbuminuria. Results of this review are mainly influenced by one small trial, hence uncertainty surrounding the effect of intensive interventions in people with type 2 diabetes and microalbuminuria still exists. Large studies are urgently required in this high risk cardiovascular group of patients.
DOI Link: 10.1016/j.diabres.2018.10.002
eISSN: 1872-8227
Embargo on file until: 9-Oct-2019
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © Elsevier for International Diabetes Federation 2018. After an embargo period this version of the paper will be an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License (, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Description: The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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