Intensive glycaemic control does not seem to reduce all cause mortality in patients with type 2 diabetes .
OBJECTIVE To assess the effect of targeting intensive glycaemic control versus conventional glycaemic control on  all cause mortality and cardiovascular mortality , non-fatal myocardial infa rct ion , microvascular complications , and severe hypoglycaemia in patients with type 2 diabetes .
Diabetes Care Protocol: effects on patient-important outcomes. A cluster randomized, non-inferiority trial in primary care.
AIMS The Diabetes Care Protocol ( DCP ) combines task delegation , intensification of diabetes treatment and feedback . It reduces cardiovascular risk in Type 2 diabetes ( T2DM ) patients . This study determines the effects of DCP on patient-important outcomes . METHODS A cluster r and omized , non-inferiority trial , by self-administered question naires in 55 Dutch primary care practice s : 26 practice s DCP ( 1699 patients ) , 26 usual care ( 1692 patients ) . T2DM patients treated by their general practitioner were included . Main outcome was the 1-year between-group difference in Diabetes Health Profile ( DHP-18 ) total score . SECONDARY OUTCOMES DHP-18 subscales , general perceived health [ Medical Outcomes Study 36-Items Short Form Health Survey ( SF-36 ) , Euroqol 5 Dimensions ( EQ-5D ) and Euroqol visual analogue scale ( EQ-VAS ) ] , treatment satisfaction ( Diabetes Treatment Satisfaction Question naire ; DTSQ status ) and psychosocial self-efficacy ( Diabetes Empowerment Scale Short Form ; DES-SF ) . Per protocol ( PP ) and intention-to-treat ( ITT ) analyses were performed : non-inferiority margin Delta=-2 % . At baseline 2333 question naires were returned and 1437 1 year thereafter . RESULTS Comparing DCP with usual care , DHP-18 total score was non-inferior : PP -0.88 ( 95 % CI -1.94 to 0.12 ) , ITT -0.439 ( 95 % CI -1.01 to 0.08 ) , SF-36 ' health change ' improved : PP 3.51 ( 95 % CI 1.23 to 5.82 ) , ITT 1.91 ( 95 % CI 0.62 to 3.23 ) , SF-36 ' social functioning ' was inconclusive : PP-1.57 ( 95 % CI-4.3 to 0.72 ) , ITT-1.031 ( 95 % CI-2.52 to -0.25 ) . Other DHP and SF-36 scores were inconsistent or non-inferior . DHP-18 ' disinhibited eating ' was significantly worse in PP analyses . For EQ-5D/EQ-VAS , DTSQ and DES-SF , no significant between-group differences were found . CONCLUSION DCP does not seem to influence health status negatively , therefore diabetes care providers should not shrink from intensified treatment . However , they should take possible detrimental effects on ' social functioning ' and  ' disinhibited eating '  into account
Intensive glycaemic control does not seem to reduce all cause mortality in patients with type 2 diabetes .
OBJECTIVE To assess the effect of targeting intensive glycaemic control versus conventional glycaemic control on  all cause mortality and cardiovascular mortality , non-fatal myocardial infa rct ion , microvascular complications , and severe hypoglycaemia in patients with type 2 diabetes .