Glucose Control in Type 2 Diabetes

Does Glucose Control in Type 2 Diabetes Affect Cardiovascular Risk?

Journal Watch Cardiology
December 17, 2008.

"The median HbA_1c stabilized by 6 months at 8.4% in the standard-therapy group and at 6.9% in the intensive-therapy group. At a median follow-up of 5.6 years, no significant benefit in the primary outcome was associated with intensive therapy (hazard ratio, 0.88; P=0.14). Ninety-five deaths occurred in the standard-therapy group, and 102 occurred in the intensive-therapy group (HR, 1.07; P=0.62). The two groups did not differ in the incidence of microvascular complications, including retinopathies, neuropathies, and nephropathies."

Comment

Three studies have now failed to show that intensive glucose control in type 2 diabetes reduces the risk for cardiovascular events. Of the three, the present cohort had the highest mean HbA_1c levels at baseline and after standard therapy; the mean HbA_1C level achieved in the intensive-therapy group was the same as that achieved in ADVANCE* and slightly higher than that achieved in ACCORD*. The authors conclude that control of hypertension, dyslipidemia, and other cardiovascular risk factors, rather than a focus on intensive control of glucose, is the most effective preventive approach in these patients. Critics might wonder if treatment earlier in the course of diabetes or longer follow-up would have altered this study's findings (JW Cardiol Oct 15 2008).

*Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial

*Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial.

Article at : http://cardiology.jwatch.org/cgi/content/full/2008/606/1