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Glycemic control and vascular complications in type 2 diabetes mellitus - UpToDate
[tl;dr: Glycemic control improves microvascular outcomes in type 2 diabetes, including progression of nephropathy, manifestation and progression of retinopathy, and retinal photocoagulation; and showed a beneficial effect of intensive therapy on the development of more advanced clinical outcomes in renal disease and its precursors in the one study with long-enough follow up to assess effect. Cardiovascular risk benefit "has not been established as clearly" for type 2 as for type 1.]

Although the role of glycemic control on microvascular disease in type 2 diabetes was documented in the United Kingdom Prospective Diabetes Study (UKPDS), its role in reducing cardiovascular risk has not been established as clearly for type 2 diabetes....

improving glycemic control improves microvascular outcomes, as illustrated by the findings of a meta-analysis of randomized trials (34,912 participants) [5]. There was a reduction in the risk of microvascular complications (a composite outcome including progression of nephropathy, manifestation and progression of retinopathy, and retinal photocoagulation) in the intensive compared with standard glycemic control group (relative risk [RR] 0.88, 95% CI 0.82-0.95). There were significant reductions in risk for each of the individual components.

In other meta-analyses of trials (over 28,000 adults) evaluating the benefits of intensive versus conventional glycemic control specifically on renal outcomes, there was a statistically significant reduction in the risk of microalbuminuria and macroalbuminuria in patients randomly assigned to intensive glycemic control (risk ratios of 0.86 and 0.74, respectively) [6,7]. The reduction in risk of end-stage renal disease did not reach statistical significance (RR 0.69, 95% CI 0.46-1.05). There was no reduction in the risk of doubling of the serum creatinine level or death from renal disease (RRs 1.06 and 0.99, respectively) [6]. Of note, the majority of the trials in the meta-analyses were not of long enough duration to show a beneficial effect of glycemic control on end-stage renal disease, which typically manifests after 10 to 20 years of diabetes duration [8]. In the trials included in the meta-analyses, the absolute rates of severe renal outcomes were low in both the intensive- and conventional-therapy groups, reducing the ability of the analysis to demonstrate a benefit, if one exists. In the one trial with longer-term follow-up (United Kingdom Prospective Diabetes Study [UKPDS] cohort followed for 22 years), there was a beneficial effect of intensive therapy on the development of more advanced clinical outcomes, including renal disease
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6 days ago by Michael.Massing

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