- April 23, 2011
- Intensive glucose lowering and cardiovascular disease prevention in diabetes: reconciling the recent clinical trial data. Circulation 2010;122:2201-11
- Mazzone T.
Description of this Publication
Because the rates of diabetes are rising dramatically around the globe, the study of strategies to prevent the increased risk of cardiovascular disease (CVD) observed in patients with type 2 diabetes remains an important research topic. Although control of blood pressure and treatment with statin-type drugs strongly contribute to CVD risk reduction in patients with diabetes, there is a residual incremental CVD risk in diabetes that must be addressed. Assessing the effect of glycemic control in preventing or delaying CVD events in diabetes has been considered important for many decades. Therefore, a number of large trials have been conducted recently to evaluate the impact of tight glycemic control on CVD events in diabetes: DCCT/EDIC, UKPDS, ACCORD, ADVANCE and VADT. In type 1 diabetes, the DCCT/EDIC trial showed significant benefits of tight glycemic control on CVD reduction. However, the other trials failed to show a significant benefit of tight glycemic control on CVD rates in type 2 diabetes. Serious hypoglycemia, which was significantly more frequent in the intensive-control group, could explain the absence of benefit on CVD risk. The results of 3 meta-analyses demonstrated a benefit of improved glycemic control on nonfatal myocardial infarction but no difference in overall mortality. Several professional organizations have made recommendations for glycemic targets and a HbA1c goal of 7% is believed appropriate. They, however, emphasized that there goals need to be individualized for patients and be part of an overall risk management strategy.