Evidence map›Paper›PMID 22186981›Full record

Trial reportDiabetologia2012

Association of HbA1c levels with vascular complications and death in patients with type 2 diabetes: evidence of glycaemic thresholds.

S Zoungas, J Chalmers, T Ninomiya, Q Li, M E Cooper, S Colagiuri, G Fulcher, B E de Galan, S Harrap, P Hamet and 9 more

Registry-linked trialOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Diabetologia, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07499375 (Effect of a Peer Support Intervention on Glycemic Control and Economic Burden Among Patients With Diabetes on Follow-up at a Tertiary Hospital), which is not on this map. Cited by 141 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
141citing papers in PubMed, 14 pooled it
13.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07499375 nacompletednot on this mapstarted 2024, after this paper: background citation

Effect of a Peer Support Intervention on Glycemic Control and Economic Burden Among Patients With Diabetes on Follow-up at a Tertiary Hospital: A Randomized Controlled Trial

TypeinterventionalSponsorAddis Ababa UniversityRan2024 to 2025Enrolled100ConditionsPeer Support InterventionArmsPeer led educational intervention program
3 · Its place in the literature

Who cites it

141 citing papers in PubMed, 14 syntheses or guidelines pooled it, 352 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Guideline
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  6. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022
    Guideline
  7. Pooled it
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  12. Glucose targets for preventing diabetic kidney disease and its progression.The Cochrane database of systematic reviews · 2017
    Pooled it
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  14. Pooled it
  15. Trial
  16. Trial
  17. Trial
  18. Glycemia Reduction in Type 2 Diabetes - Microvascular and Cardiovascular Outcomes.The New England journal of medicine · 2022 · on this map
    Trial
  19. Trial
  20. Trial

81 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors at 11 institutions in 6 countries.

S ZoungasThe George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Sydney, NSW, Australia. szoungas@georgeinstitute.org.au
J Chalmers
T Ninomiya
Q Li
M E Cooper
S Colagiuri
G Fulcher
B E de Galan
S Harrap
P Hamet
S Heller
S MacMahon
M Marre
N Poulter
F Travert
A Patel
B Neal
M Woodward
ADVANCE Collaborative Group
The George Institute for Global Health · AUAssistance Publique – Hôpitaux de Paris · FRBaker Heart and Diabetes Institute · AUCentre Hospitalier de l’Université de Montréal · CAImperial College London · GBJohns Hopkins University · USRadboud University Nijmegen · NLRoyal North Shore Hospital · AUThe Royal Melbourne Hospital · AUThe University of Sydney · AUUniversity of Sheffield · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aims/hypothesisThere is conflicting evidence regarding appropriate glycaemic targets for patients with type 2 diabetes. Here, we investigate the relationship between HbA(1c) and the risks of vascular complications and death in such patients.

methodsEleven thousand one hundred and forty patients were randomised to intensive or standard glucose control in the Action in Diabetes and Vascular disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Glycaemic exposure was assessed as the mean of HbA(1c) measurements during follow-up and prior to the first event. Adjusted risks for each HbA(1c) decile were estimated using Cox models. Possible differences in the association between HbA(1c) and risks at different levels of HbA(1c) were explored using linear spline models.

resultsThere was a non-linear relationship between mean HbA(1c) during follow-up and the risks of macrovascular events, microvascular events and death. Within the range of HbA(1c) studied (5.5-10.5%), there was evidence of 'thresholds', such that below HbA(1c) levels of 7.0% for macrovascular events and death, and 6.5% for microvascular events, there was no significant change in risks (all p > 0.8). Above these thresholds, the risks increased significantly: every 1% higher HbA(1c) level was associated with a 38% higher risk of a macrovascular event, a 40% higher risk of a microvascular event and a 38% higher risk of death (all p < 0.0001). CONCLUSIONS/

interpretationIn patients with type 2 diabetes, HbA(1c) levels were associated with lower risks of macrovascular events and death down to a threshold of 7.0% and microvascular events down to a threshold of 6.5%. There was no evidence of lower risks below these levels but neither was there clear evidence of harm.

Indexed as

AgedAged, 80 and overAntihypertensive AgentsBlood GlucoseCohort StudiesDiabetes Mellitus, Type 2Diabetic AngiopathiesDrug Therapy, CombinationFemaleFollow-Up StudiesGlycated HemoglobinHumansHyperglycemiaHypertensionHypoglycemic AgentsMaleAntihypertensive AgentsBlood GlucoseGlycated Hemoglobinhemoglobin A1c protein, humanHypoglycemic Agents

Identifiers

PMID22186981
OpenAlexW2147521434

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.