title: A systematic review and meta-analysis of glycemic control for the prevention of diabetic foot syndrome.
abstract: OBJECTIVE
  The objective of this review was to synthesize the available randomized controlled trials (RCTs) estimating the relative efficacy and safety of intensive vs less intensive glycemic control in preventing diabetic foot syndrome.
  
  
  METHODS
  We used the umbrella design (systematic review of systematic reviews) to identify eligible RCTs. Two reviewers determined RCT eligibility and extracted descriptive, methodologic, and diabetic foot outcome data. Random-effects meta-analysis was used to pool outcome data across studies, and the I(2) statistic was used to quantify heterogeneity.
  
  
  RESULTS
  Nine RCTs enrolling 10,897 patients with type 2 diabetes were included and deemed to be at moderate risk of bias. Compared with less intensive glycemic control, intensive control (hemoglobin A1c, 6%-7.5%) was associated with a significant decrease in risk of amputation (relative risk [RR], 0.65; 95% confidence interval [CI], 0.45-0.94; I(2) = 0%). Intensive control was significantly associated with slower decline in sensory vibration threshold (mean difference, -8.27; 95% CI, -9.75 to -6.79). There was no effect on other neuropathic changes (RR, 0.89; 95% CI, 0.75-1.05; I(2) = 32%) or ischemic changes (RR, 0.92; 95% CI, 0.67-1.26; I(2) = 0%). The quality of evidence is likely moderate.
  
  
  CONCLUSIONS
  Compared with less intensive glycemic control therapy, intensive control may decrease the risk of amputation in patients with diabetic foot syndrome. The reported risk reduction is likely overestimated because the trials were open and the decision to proceed with amputation could be influenced by glycemic control.
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Department of Internal Medicine, University of Missouri, Columbia, Mo.
authors.forename: Rim
authors.initials: R
authors.lastname: Hasan
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Department of Internal Medicine, University of Missouri, Columbia, Mo.
authors.forename: Belal
authors.initials: B
authors.lastname: Firwana
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn.
authors.forename: Tarig
authors.initials: T
authors.lastname: Elraiyah
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia (CONEVID), Lima, Peru.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Domecq
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia (CONEVID), Lima, Peru.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Prutsky
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Nabhan
authors.affiliation: Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Peter
authors.initials: P
authors.lastname: Henke
authors.affiliation: Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tsapas
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minn.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D017719:Diabetic Foot / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents