A three-arm RCT shows 24 g/day dietary fibre improves HbA1c and the FIB-4 fibrosis marker in type 2 diabetes with MASLD. PICO summary and expert commentary for clinicians.
Browsing: Type 2 Diabetes
Landmark trials and recent evidence on type 2 diabetes management, glucose-lowering therapy, and outcomes.
CARDS demonstrated that atorvastatin 10 mg reduces major cardiovascular events by 37% and stroke by 48% in patients with type 2 diabetes and normal to mildly elevated LDL-cholesterol without prior CVD, confirming that cardiovascular risk rather than LDL level should determine statin initiation and establishing universal statin use in primary cardiovascular prevention for type 2 diabetes.
VADT demonstrated that intensive glucose control achieving a median HbA1c of 6.9% did not significantly reduce cardiovascular events or mortality in veterans with long-standing type 2 diabetes and high cardiovascular disease prevalence, completing the ACCORD/ADVANCE/VADT triptych that defined the limits of aggressive glycaemic management in advanced disease.
ADVANCE demonstrated that intensive glucose control targeting HbA1c below 6.5% using a gliclazide-based strategy reduces nephropathy by 21% and the microvascular composite by 14% in high-risk type 2 diabetes, without the mortality hazard observed in ACCORD, providing important context for how glycaemic targets and treatment strategies interact with safety outcomes.
ACCORD demonstrated that targeting an HbA1c below 6.0% in high-risk type 2 diabetes patients with established cardiovascular disease increased all-cause mortality by 22% without significantly reducing cardiovascular events, establishing that very intensive glycaemic targets are harmful in this population and reshaping international guidelines to mandate individualised HbA1c targeting.
Steno-2 demonstrated that intensive multifactorial risk factor intervention targeting glycaemia, blood pressure, lipids, and lifestyle simultaneously reduces all-cause mortality by 46% and cardiovascular events by 59% over 13.3 years in type 2 diabetes with microalbuminuria, providing the defining evidence for comprehensive cardiovascular risk management in high-risk type 2 diabetes.
UKPDS 38 demonstrated that tight blood pressure control targeting below 150/85 mmHg reduces stroke by 44%, diabetes-related endpoints by 24%, and microvascular complications by 37% in hypertensive type 2 diabetes over 8.4 years, establishing blood pressure control as a therapeutic target of at least equal macrovascular importance to glycaemic management.
UKPDS 34 demonstrated that metformin reduces diabetes-related endpoints, death, and all-cause mortality by 32–42% in overweight patients with newly diagnosed type 2 diabetes, with superior cardiovascular outcomes compared with sulphonylurea or insulin, establishing metformin as the preferred first-line pharmacological therapy for type 2 diabetes for the subsequent three decades.
UKPDS 33 established that intensive blood-glucose control with sulphonylurea or insulin reduces microvascular complications by 25% in newly diagnosed type 2 diabetes over 10 years with a 0.9% HbA1c differential, confirming the glucose hypothesis for type 2 diabetes microvascular disease and forming the foundational evidence for tight glycaemic management from diagnosis.
An RCT reports resistance exercise plus metformin improves glycaemic control and sleep quality in elderly type 2 diabetes with sleep disorders. PICO summary and expert commentary.