Evidence map›Paper›PMID 26511332›Full record

Observational studyDiabetes, obesity & metabolism2016

Relationship of glycaemic control and hypoglycaemic episodes to 4-year cardiovascular outcomes in people with type 2 diabetes starting insulin.

N Freemantle, N Danchin, F Calvi-Gries, M Vincent, P D Home

Open access · hybridAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Diabetes, obesity & metabolism, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 3 pooled it
3.1field-weighted citation impact, top 8% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 3 syntheses or guidelines pooled it, 33 citations in OpenAlex.

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  17. Impact of a Novel Insulin Management Service on Non-insulin Pharmaceutical Expenses.Journal of health economics and outcomes research · 2018
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 4 institutions in 2 countries.

N FreemantleDepartment of Primary Care and Population Health, University College London, London, UK.
N DanchinDepartment of Medicine, University of Paris René Descartes, Paris, France.
F Calvi-GriesAtlanStat, Rezé, France.
M VincentSanofi, Paris, France.
P D HomeInstitute of Cellular Medicine-Diabetes, Newcastle University, Newcastle upon Tyne, UK.
Délégation Paris 5 · FRNewcastle University · GBSanofi (France) · FRUniversity College London · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo examine the relationships between glycated haemoglobin (HbA1c) and cardiovascular (CV) events in people beginning insulin in routine clinical practice in Europe, North America and Asia in a non-interventional study, the Cardiovascular Risk Evaluation in people with Type 2 Diabetes on Insulin Therapy (CREDIT) study.

methodsData on 2999 people were collected prospectively over 4 years from physician reports. The primary outcome was the composite of stroke or myocardial infarction (MI) or CV-specific death. Events were blindly adjudicated. The relative hazards of CV events were described from Cox proportional hazards models incorporating patient risk factors, with updated average HbA1c as a time-dependent covariate. The relationship of severe and symptomatic hypoglycaemia (collected during the 6 months before yearly ascertainment) with CV and all-cause mortality was examined.

resultsA total of 147 primary events were accrued during up to 54 months of follow-up. In all, 60 CV-specific deaths, 44 non-fatal MIs and 57 non-fatal strokes occurred, totalling 161 events. There was a significant positive relationship between updated mean HbA1c and primary outcome: hazard ratio (HR) 1.25 [95% confidence interval (CI) 1.12-1.40; p < 0.0001]. CV death [HR 1.31 (95% CI 1.10-1.57); p = 0.0027] and stroke [HR 1.36 (95% CI 1.17-1.59); p < 0.0001] were both strongly associated with HbA1c, while MI was not [HR 1.05 (95% CI 0.83-1.32)]. One or more severe hypoglycaemic episodes affected 175 participants, while 1508 participants experienced one or more symptomatic hypoglycaemic events. We found no relationship between severe/symptomatic hypoglycaemic events and CV-specific/all-cause death.

conclusionsOngoing poorer glucose control was associated with CV events; hypoglycaemia was not associated with CV-specific/all-cause death.

Indexed as

AgedCanadaCardiovascular DiseasesDiabetes Mellitus, Type 2Diabetic AngiopathiesDiabetic CardiomyopathiesEuropeFemaleGlycated HemoglobinHumansHyperglycemiaHypoglycemiaHypoglycemic AgentsInsulinJapanLongitudinal StudiesGlycated Hemoglobinhemoglobin A1c protein, humanHypoglycemic AgentsInsulincardiovascular riskCREDITglycaemic controlhypoglycaemiatype 2 diabetes

Identifiers

PMID26511332
PMCPMC4738470
OpenAlexW1884422090

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

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.