Clinical evidence summaries for type 2 diabetes, including glycaemic therapies, cardiovascular outcomes, kidney protection, complications, technology, obesity, and long-term safety.
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.
An RCT finds adding a ketogenic diet to dulaglutide improves glucose, lipids, and insulin resistance in type 2 diabetes. PICO summary and clinical expert commentary.
An RCT finds a structured lifestyle-based programme improves health behaviours and beliefs in type 2 diabetes, though without glycaemic endpoints. PICO summary and expert commentary.
An RCT finds combining exercise with broccoli sprout supplementation improves apolipoproteins in type 2 diabetes, mainly driven by exercise. PICO summary and expert commentary.
The DAPAHEART follow-up finds 4 years of dapagliflozin improves coronary flow reserve and reduces epicardial fat in type 2 diabetes. PICO summary and expert commentary.
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