Less Is More

Simpler & Better Medicine

Comparative effectiveness of exercise and drug interventions on mortality outcomes — May 16, 2017

Comparative effectiveness of exercise and drug interventions on mortality outcomes

Summary: For patients who have had a stroke, exercise-based rehabilitation (including cardiorespiratory and muscle strengthening exercises) is more effective than medication (either anti-platelet agents or anticoagulants) for reducing mortality; while for patients with established coronary artery disease both medications and exercise-based rehabilitation provide the same (small) reduction in mortality; and for patients with pre-diabetes neither exercise-based rehabilitation nor medications are effective at reducing mortality.

https://www.ncbi.nlm.nih.gov/m/pubmed/26476429/

Strength of Recommendation = A

Mortality in Individuals Aged 80 and Older with Type 2 Diabetes Mellitus in Relation to Glycosylated Hemoglobin, Blood Pressure, and Total Cholesterol. — March 3, 2017

Mortality in Individuals Aged 80 and Older with Type 2 Diabetes Mellitus in Relation to Glycosylated Hemoglobin, Blood Pressure, and Total Cholesterol.

Summary: For patients over 80 with type 2 diabetes, mortality risk may be lower with intermediate levels of glycosylated hemoglobin, blood pressure, and cholesterol, compared to higher mortality risk in patients with lower levels of glycosylated hemoglobin, blood pressure, and cholesterol.

https://www.ncbi.nlm.nih.gov/m/pubmed/27295278/

Strength of Recommendation = B

Short- and long-term outcomes of metformin compared with insulin alone in pregnancy. — February 3, 2017

Short- and long-term outcomes of metformin compared with insulin alone in pregnancy.

Summary: For women with gestational or Type 2 diabetes mellitus, using metformin during pregnancy may be associated with lower risks of neonatal hypoglycemia, large for gestational age babies, pregnancy-induced hypertension and total maternal pregnancy weight gain compared to using insulin; however there remains little information on long-term outcomes.

https://www.ncbi.nlm.nih.gov/m/pubmed/27150509/

Strength of Recommendation = B

Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus — May 24, 2016

Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus

Summary: For patients with type 2 diabetes (T2DM) and a systolic blood pressure less than 140 mmHg, avoiding additional antihypertensive treatment is associated with a lower risk of cardiovascular mortality compared to adding additional antihypertensive treatment to patients with T2DM and a SBP < 140 mmHg.

(Note: For patients with T2DM and a SBP > 140, this meta-analysis demonstrates benefits for all-cause mortality with treatment to further lower BP).

http://www.ncbi.nlm.nih.gov/m/pubmed/26920333/

Strength of Recommendation = A

Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. — October 2, 2015

Benefits and risks of tight glucose control in critically ill adults: a meta-analysis.

Summary: For critically ill adult patients (ie, adults in intensive care for a medical illness), “usual” glucose control is associated with a lower risk of hypoglycemia than “tight” glucose control without any significant increase in hospital mortality (however, “usual” glucose control may be associated with a slightly increased risk of septicemia)

www.ncbi.nlm.nih.gov/m/pubmed/18728267

Strength of Recommendation = A

Intensive versus conventional glucose control in critically ill patients. — September 18, 2015

Intensive versus conventional glucose control in critically ill patients.

Summary: For patients with diabetes requiring intensive-care unit (ICU) care expected to last 3 or more days, a less-strict blood sugar target of 180 mg/dL or less may decrease the risk of death within 90 days compared to a more strict blood sugar target range of 81 to 108 mg/dL. (In other words, in this trial, patients randomized to the “tighter” blood sugar target range had a higher risk of dying than those randomized to “less-strict” blood sugar control)

http://www.ncbi.nlm.nih.gov/m/pubmed/19318384/

Strength of Recommendation = B

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