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Buehler AM. Effect of intensive glycaemic control versus conventional control in patients with Diabetes Mellitus type II: A systematic review with meta-analysis of randomized controlled trials [Ph.D. thesis (Physiology and Biophysics)]. São Paulo: Instituto de Ciências Biomédicas da Universidade de São Paulo; 2010. Data of larger clinical trials have showed more intensive diabetes control prevents microvascular events with both type 1 and type 2 diabetes. However whether intensive control of glucose reduces cardiovascular events and total mortality is conflicting. We summarize clinical effects of intensive versus conventional glucose control in patients with type 2 diabetes. So, we systematically searched the main electronic data bases Medline, Embase, Cochrane Library and ISI of Knowledge with no limits of language and time. Two independents reviewers screened title and abstracts and full-text articles to include randomized controlled trials with type 2 diabetes patients which aimed two levels of intensity glycemic and a follow-up period for at least one year. We investigated microvascular events (retinopathies, visual deteriorization, neuropathies, and nephropathies), cardiovascular events (cardiocascular mortality, non-fatal myocardial infarction (MI), non-fatal stroke and limb amputation), all-cause mortality and hypoglycemic episodes. We used a random-effects meta-analysis to obtain a relative risk (RR) effects estimates and assessed statistical heterogeneity across trials using I 2 statistics. We included 7 trials involving 27,814 patients. For cardiovascular events, intensive glucose control reduced the relative risk for non-fatal MI in 17% [RR 0.83 95%CI (0.71-0.97)] and limb amputation in 36% [RR 0.64 95%CI (0.43-0.96)]. For microvascular events, intensive glucose control reduced the risk progression of retinopathy [RR 0.80 95% IC (0.71-0.91)], incidence of peripheral neuropathy [RR 0.94 95%IC (0.89-0.99)], incidence of nephropathy [RR 0.65 95% CI (0.43-0.98)], progression of nephropathy [RR 0.55 95%IC (0.37-0.80)] and incidence of microalbuminuria [RR 0.78 95%IC (0.65-0.92)]. Related to hypoglycemic events, intensive glucose control rises the risk of major hypoglycemic episodes up to 97% [RR 1,97 95%IC (1.33-2.92)]. There were no differences between intensive and conventional glucose control regarding all causes of mortality, cardiovascular mortality and others outcomes. We have concluded that Intensive glucose control reduced the risk for some macrovascular and microvascular events, without reduction on all-cause mortality and cardiovascular mortality. Also, it increases the risk for major hypoglycemic episodes.

Controle glicêmico intensivo versus controle glicêmico convencional em pacientes portadores de diabetes melito tipo II: revisão sistemática e meta-análise de ensaios clínicos randomizados.