"Intensive Glucose Control in Type 2 Diabetes". The New England Journal of Medicine. 2009. 360:129-139. PubMed
Links to original sources: Wiki Journal Post Full Journal Article
Does intensive glucose control reduce the rate of major cardiovascular events among patients with long-standing type 2 diabetes?
Intensive glucose control in patients with poorly controlled type 2 diabetes did not significantly reduce the rate of major cardiovascular events, death, or microvascular complications, except for a reduction in the progression of albuminuria.
The effects of intensive glucose control on cardiovascular events in veteran patients with poorly controlled type 2 diabetes and a high cardiovascular risk profile were investigated in the Veterans Affairs Diabetes Trial (VADT). The results did not show a significant reduction in the composite of cardiovascular events with intensive therapy compared to standard therapy over a median follow-up of 5.6 years.
As of the last knowledge update for this summary, no specific guidelines have been generated based on this trial. However, guidelines generally suggest individualized glucose targets for patients with type 2 diabetes, taking into account the risk of hypoglycemia, patient preference, and disease duration.
- Multicenter, open-label, randomized, controlled trial - N=1791 military veterans with type 2 diabetes and suboptimal response to therapy - Intensive therapy (n=891); Standard therapy (n=900) - Setting: 20 VA medical centers in the U.S. - Enrollment: 2000-2003 - Follow-up: median 5.6 years - Analysis: Intention-to-treat - Primary outcome: Time to the first major cardiovascular event
- Inclusion criteria: Military veterans with type 2 diabetes and suboptimal response to therapy, glycated hemoglobin level >7.5% - Exclusion criteria: Recent cardiovascular event, advanced heart failure, limited life expectancy, BMI >40, creatinine >1.6 mg/dL, and alanine aminotransferase >3× upper limit of normal - Baseline characteristics: Mean age 60.4 years, 11.5 years since diabetes diagnosis, 40% had a cardiovascular event, 72% had hypertension
- Intensive therapy group: Goal glycated hemoglobin level reduction of 1.5% compared to the standard-therapy group - Standard therapy group: Less aggressive glycemic targets - Similar treatment for other cardiovascular risk factors
- Primary Outcome: No significant difference in the time to the first occurrence of a major cardiovascular event between groups (HR 0.88; 95% CI 0.74 to 1.05; P=0.14) - Secondary Outcomes: No significant difference in any of the individual components of the primary outcome or in all-cause death (HR 1.07; 95% CI 0.81 to 1.42; P=0.62) - Adverse Events: Higher rate of hypoglycemia in the intensive-therapy group (24.1%) compared to standard-therapy group (17.6%, P=0.05)
- Primarily male veteran population may limit generalizability to other groups - Lack of double-blind design may have introduced bias - Potential for newer agents to have different effects not considered in the trial protocol
- Veterans Affairs Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development, pharmaceutical and other supplies and financial assistance from GlaxoSmithKline, Novo Nordisk, Roche Diagnostics, Sanofi-Aventis, Amylin, and Kos Pharmaceuticals.
- Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129-139.