Blutzucker so früh wie möglich gut einstellen
Fazit aus den vier großen Diabetesstudien 2008: (ACCORD,
ADVANCE, VADT und UKPDS-10-Jahres-Daten)

Lesen Sie dazu auch die Veröffentlichungen im Lancet, Vol. 373 No.9677 vom 23. Mai 2009:
Seite 1765:
Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trialsKausik
K Ray, Sreenivasa Rao Kondapally Seshasai, Shanelle Wijesuriya, Rupa Sivakumaran, Sarah Nethercott, David Preiss, Sebhat Erqou, Naveed Sattar
Summary

Background

Whether intensive control of glucose reduces macrovascular events and all-cause mortality in individuals with type 2 diabetes mellitus is unclear. We undertook a meta-analysis of randomised controlled trials to determine whether intensive treatment is beneficial.

Methods

We selected five prospective randomised controlled trials of 33 040 participants to assess the effect of an intensive glucose-lowering regimen on death and cardiovascular outcomes compared with a standard regimen. We gathered information about events of non-fatal myocardial infarction, coronary heart disease (fatal and non-fatal myocardial infarction), stroke, and all-cause mortality, and did a random-effects meta-analysis to obtain summary effect estimates for the clinical outcomes with use of odds ratios calculated from the raw data of every trial. Statistical heterogeneity across trials was assessed with the χ2 and I2 statistics.

Findings

The five trials provided information on 1497 events of non-fatal myocardial infarction, 2318 of coronary heart disease, 1127 of stroke, and 2892 of all-cause mortality during about 163 000 person-years of follow-up. The mean haemoglobin A1c concentration (HbA1c) was 0·9% lower for participants given intensive treatment than for those given standard treatment. Intensive glycaemic control resulted in a 17% reduction in events of non-fatal myocardial infarction (odds ratio 0·83, 95% CI 0·75—0·93), and a 15% reduction in events of coronary heart disease (0·85, 0·77—0·93). Intensive glycaemic control had no significant effect on events of stroke (0·93, 0·81—1·06) or all-cause mortality (1·02, 0·87—1·19).

Interpretation

Overall, intensive compared with standard glycaemic control significantly reduces coronary events without an increased risk of death. However, the optimum mechanism, speed, and extent of HbA1c reduction might be different in differing populations.

und den Kommentar auf Seite 1737:
Hyperglycaemia and coronary heart disease: the meta pictureTheodore Mazzone
In The Lancet today, Kausik Ray and colleagues1 report on the results of a meta-analysis of five carefully executed trials that examined the effect of glucose control on coronary heart disease in patients with type 2 diabetes.2–7 They report significant 17% and 15% reductions in events of non-fatal myocardial infarction and coronary heart disease, respectively, with better control of blood sugar. Because none of these trials individually reported a significant reduction in primary endpoints for coronary heart disease, a reasonable question is whether the results of this meta-analysis are important and, more broadly, why is there continuing interest in the importance of hyperglycaemia for accelerating coronary heart disease in patients with diabetes?