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

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], nonfatal 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. Crown Copyright (C) 2018 Published by Elsevier B.V. All rights reserved.