Efficacy of intensive control of glucose in stroke prevention: a meta-analysis of data from 59,197 participants in 9 randomized controlled trials

Abstract

Background: The efficacy of treatments that lower glucose in reducing the risk of incident stroke remains unclear. We therefore did a systematic review and meta-analysis to evaluate the efficacy of intensive control of glucose in the prevention of stroke.

Methodology/principal findings: We systematically searched Medline, EmBase, and the Cochrane Library for trials published between 1950 and June, 2012. We included randomized controlled trials that reported on the effects of intensive control of glucose on incident stroke compared with standard care. Summary estimates of relative risk (RR) reductions were calculated with a random effects model, and the analysis was further stratified by factors that could affect the treatment effects. Of 649 identified studies, we included nine relevant trials, which provided data for 59,197 patients and 2037 events of stroke. Overall, intensive control of glucose as compared to standard care had no effect on incident stroke (RR, 0.96; 95%CI 0.88-1.06; P = 0.445). In the stratified analyses, a beneficial effect was seen in those trials when body mass index (BMI) more than 30 (RR, 0.86; 95%CI: 0.75-0.99; P = 0.041). No other significant differences were detected between the effect of intensive control of glucose and standard care when based on other subset factors.

Conclusions/significance: Our study indicated intensive control of glucose can effectively reduce the risk of incident stroke when patients with BMI more than 30.

Figure 1. Flow diagram of the literature search and trials selection process.

Figure 2. Effect of intensive control of glucose on risk of stroke.

Figure 3. Meta-regression of (A: P = 0.242) baseline BMI, (B: P = 0.454) baseline glycosylated hemoglobin, and (C: P = 0.196) duration of follow-up for incident stroke.