Summary of findings for the main comparison. Tight glycaemic control compared with non‐tight control for preventing diabetic kidney disease (DKD) and its progression.
| Tight glycaemic control compared with non‐tight control for preventing DKD and its progression | ||||||
|
Patient or population: patients with diabetes Intervention: tight glycaemic control Comparison: non‐tight glycaemic control | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Confidence of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Non‐tight control | Tight control | |||||
|
Doubling serum creatinine 8.3 years |
39 per 1000 |
33 per 1000 (24.95 to 43.29) NNT: 167 |
RR 0.84 (0.64 to 1.11) | 26,874 (4) | ⊕⊕⊝⊝ low | Imprecision (‐1) Heterogeneity (‐1) |
|
ESKD 5.9 years |
3 per 1000 |
2 per 1000 (1.02 to 3.36) NNT: 1000 |
RR 0.62 (0.34 to 1.12) | 23,332 (4) | ⊕⊕⊝⊝ low | Imprecision (‐1) Heterogeneity (‐1) |
|
Sudden death 4.6 years |
2 per 1000 |
2 per 1000 (0.52 to 5.14) NNT: 0 |
RR 0.82 (0.26 to 2.57) | 5,913 (4) | ⊕⊝⊝⊝ very low | Study limitation (‐1) Imprecision (‐1) Heterogeneity (‐1) |
|
All‐cause mortality 5.6 years |
16 per 1000 |
16 per 1000 (13.76‐18.08) NNT: 0 |
RR 0.99 (0.86 to 1.13) | 29,094 (9) | ⊕⊕⊕⊝ moderate | Imprecision (‐1) |
|
Cardiovascular mortality 4.4 years |
9 per 1000 |
11 per 1000 (6.57 to 17.28) NNH: 500 |
RR 1.19 (0.73 to 1.92) | 23,673 (6) | ⊕⊕⊝⊝ low | Imprecision (‐1) Heterogeneity (‐1) |
|
Non‐fatal myocardial infarction 5.6 years |
8 per 1000 |
7 per 1000 (5.36 to 7.92) NNT: 1000 |
RR 0.82 (0.67 to 0.99) | 25,596 (5) | ⊕⊕⊕⊝ moderate | Study limitation (‐1) |
|
Onset microalbuminuria 5.4 years |
46 per 1000 |
39 per 1000 (35.42 to 43.24) NNT: 143 |
RR 0.85 (0.77 to 0.94) | 19,933 (4) | ⊕⊕⊕⊝ moderate | Heterogeneity (‐1) |
|
Progression of microalbuminuria 5.8 years |
4 per 1000 |
2 per 1000 (1.52 to 3.72) NNT: 500 |
RR 0.59 (0.38 to 0.93) | 13,266 (5) | ⊕⊕⊕⊝ moderate | Heterogeneity (‐1) |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is calculated from data in the meta‐analyses. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence Interval; RR: Risk Ratio; NNT: Number Needed to Treat; NNH: Number Needed to Harm. We did not downgrade for reason of publication bias as insufficient studies contributed to treatment estimates to draw meaningful conclusions | ||||||
| GRADE Working Group grades of evidence High confidence: Further research is very unlikely to change our confidence in the estimate of effect. Moderate confidence: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low confidence: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low confidence: We are very uncertain about the estimate. | ||||||
ESKD ‐ end‐stage kidney disease