Glucose control and vascular complications in veterans with type 2 diabetes.

By W. Duckworth, C. Abraira, Thomas E. Moritz, D. Reda, N. Emanuele, P. Reaven, F. Zieve, J. Marks, S. Davis, Rodney A. Hayward and 6 more. New England Journal of Medicine, 2009

4,406 citations recorded by the source corpus.

BACKGROUND The effects of intensive glucose control on cardiovascular events in patients with long-standing type 2 diabetes mellitus remain uncertain. METHODS We randomly assigned 1791 military veterans (mean age, 60.4 years) who had a suboptimal response to therapy for type 2 diabetes to receive either intensive or standard glucose control. Other cardiovascular risk factors were treated uniformly. The mean number of years since the diagnosis of diabetes was 11.5, and 40% of the patients had already had a cardiovascular event. The goal in the intensive-therapy group was an absolute reduction of 1.5 percentage points in the glycated hemoglobin level, as compared with the standard-therapy group. The primary outcome was the time from randomization to the first occurrence of a major cardiovascular event, a composite of myocardial infarction, stroke, death from cardiovascular causes, congestive heart failure, surgery for vascular disease, inoperable coronary disease, and amputation for ischemic gangrene. RESULTS The median follow-up was 5.6 years. Median glycated hemoglobin levels were 8.4% in the standard-therapy group and 6.9% in the intensive-therapy group. The primary outcome occurred in 264 patients in the standard-therapy group and 235 patients in the intensive-therapy group (hazard ratio in the intensive-therapy group, 0.88; 95% confidence interval [CI], 0.74 to 1.05; P=0.14). There was no significant difference between the two groups in any component of the primary outcome or in the rate of death from any cause (hazard ratio, 1.07; 95% CI, 0.81 to 1.42; P=0.62). No differences between the two groups were observed for microvascular complications. The rates of adverse events, predominantly hypoglycemia, were 17.6% in the standard-therapy group and 24.1% in the intensive-therapy group. CONCLUSIONS Intensive glucose control in patients with poorly controlled type 2 diabetes had no significant effect on the rates of major cardiovascular events, death, or microvascular complications with the exception of progression of albuminuria (P = 0.01) [added]. (ClinicalTrials.gov number, NCT00032487.)

Subfields: Endocrinology, Diabetes and Metabolism

View Paper: https://www.semanticscholar.org/paper/0905c5577c0e796e2b98a9fb49fc40f726a3702a

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In Endocrinology, Diabetes and Metabolism

1. V. Basevi
2. Peter Libby
3. Ralph DeFronzo
4. G. Hansson
5. I. Graham
6. J. Forbes
7. M. Woodward
8. T. Ivanova

Citations in the corpus

• Standards of Medical Care in Diabetes—2012 (2011, background): “9%) compared with standard glycemic control but no difference in retinopathy and neuropathy (76,77).”
• CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM--2016 EXECUTIVE SUMMARY. (2016, background): “Severe hypoglycemia occurs more frequently with intensive glycemic control (72,75,77,79).”
• 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) (2007, background): “The appropriate target for a glycaemic control has been explored recently in the ADVANCE [664], ACCORD [665], and Veterans’ Affairs Diabetes Trial (VADT) [666] studies, which randomized one study arm to very low HbA1c targets (<6.”
• European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (Version 2012) (2012, neutral): “4% (68 mmol/mol) in the standard group.(438) There was no significant difference between groups for any of the individual composites of the primary outcome or for all-cause mortality.”
• Mechanisms of diabetic complications. (2013, background): “Conversely, the apparent lack of effect of glycemic control in preventing the progression of CVD, seen in studies such as ADVANCE, VADT (165), and ACCORD (203, 454), may also be related to lower cellular glucose uptake in the context of a high utilization of free fatty acids, although this remains t”
• 2013 ESH/ESC Guidelines for the management of arterial hypertension (2007, background): “The appropriate target for a glycaemic control has been explored recently in the ADVANCE [664], ACCORD [665], and Veterans’ Affairs Diabetes Trial (VADT) [666] studies, which randomized one study arm to very low HbA1c targets (<6.”
• Diabetes in Older Adults (2012, background): “Over 5 years of follow-up, the VADT found no statistically significant effect of intensive glucose control on major cardiovascular events or death, but it did find significant reductions in onset and progression of albuminuria (30).”