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Coca et al examined the effect of intensive glycemic control vs conventional glucose control on renal outcomes in patients with type 2 diabetes mellitus through a systematic literature review and meta-analysis. While intensive glycemic controls appear to reduce the risk of development of microalbuminuria and macroalbuminuria, evidence is lacking that they reduce the risk of significant clinical renal outcomes such as doubling of creatinine level, end-stage renal disease, or death from renal disease during the follow-up years of the trials. The authors explore several reasons for these findings.
Collet et al combined individual data on 52 674 participants from 10 prospective cohort studies in the United States, Europe, Brazil, and Australia. At baseline, 2188 (4.2%) participants had subclinical hyperthyroidism. During follow-up, 8527 participants died (including 1896 from coronary heart disease [CHD]), 3653 had CHD events, and 785 developed atrial fibrillation (AF). In age- and sex-adjusted analyses (hazard ratio; 95% CI), subclinical hyperthyroidism was associated with increased total mortality (1.24; 1.06-1.46), CHD mortality (1.29; 1.02-1.62), CHD events (1.21; 0.99-1.46), and AF (1.68; 1.16-2.43). Risks for CHD mortality and AF increased with lower thyrotropin levels, and were highest among those with a thyrotropin level lower than 0.10 mIU/L (for both, P value for trend, ≤.03). These findings of increased risks of total mortality, CHD mortality, and AF associated with subclinical hyperthyroidism, with greater risks of CHD mortality and AF among those with a thyrotropin level lower than 0.10 mIU/L, are consistent with recent treatment guidelines for subclinical hyperthyroidism.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2012;172(10):757. doi:10.1001/archinternmed.2011.947
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