- While there is no debate about the intensive statin therapy to lower LDL-C and the use of multiple medications to lower blood pressure in people with diabetes, there is a raging controversy regarding tight control of blood sugar with insulin in people with diabetes.
- The most recent meta-analysis of 13 studies involving 34,533 patients showed no reduction in cardiovascular death or all cause death among the 18,315 who received intensive glucose lowering treatment compared to the 16,218 who received standard treatment.1
- Intensive treatment however, was associated with a 15% reduction in the risk of heart attack, , and 10% in the risk of microalbuminuria (an indicator of kidney damage); there was a 47% increase in risk of congestive heart failure and 100% increase in the risk of severe hypoglycemia (low blood sugar).
- Besides, a 19% increase in all-cause mortality and a 43% increase in death from cardiovascular causes could not be ruled out.1
- Over a treatment period of 5 years, 117-150 patients would need to be treated to avoid one heart attack and 32-142 patients to avoid one episode of microalbuminuria, whereas one severe episode of hypoglycemia would occur for every 15-52 patients.
- For now, intensive glucose lowering treatment of diabetes (type 2) should not be considered routinely, and therapeutic escalation should be limited except in selected cases where good control of blood sugar can be achieved without insulin or oral agents that produce low blood sugar.2
1. Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M, et al. Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials. BMJ. 2011;343:d4169.
2. Enas E.A., Hancy Chennikkara Pazhoor MD, Arun Kuruvila MBBS, Krishnaswami Vijayaraghavan MD F. Intensive Statin Therapy for Indians:Part I Benefits. Indian Heart J 2011; 63: 211-227.