Intensive treatment of hyperglycaemia: what are the objectives?

摘要

In his Comment (Aug 7, p 391) on the results of the ACCORD Study, Ronald Klein speculates that the premature termination of the study, consequent on the 22% excess mortality in the intensive glycaemic treatment group, might have resulted in the study being underpowered to show benefit for severe microvascular endpoints. To explore this possibility, we have analysed the effects of intensive glycaemic control on blindness and end-stage renal failure (ESRF) in some 27000 patients with type 2 diabetes in the four major outcome studies. Expressing the estimates as absolute, rather than relative, risk reductions (table), we calculate that intensive glycaemic treatment of 1000 patients for 5 years, resulting in a 0.9% lower glycated haemoglobin level, would prevent 3.7 people (95% Cl -6.1 to 12.3) from developing blindness in one eye and 1.6 people (-1.5 to 4.0) from developing ESRF. During this treatment, seven fewer people would have a myocardial infarction, but 47 more a severe hypoglycaemic event. Cardiovascular and all-cause mortality would be unaffected.