Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes

• Published in: The New England journal of medicine Vol. 360; no. 2; pp. 129 - 139
• Main Authors: Duckworth, William, Abraira, Carlos, Moritz, Thomas, Reda, Domenic, Emanuele, Nicholas, Reaven, Peter D, Zieve, Franklin J, Marks, Jennifer, Davis, Stephen N, Hayward, Rodney, Warren, Stuart R, Goldman, Steven, McCarren, Madeline, Vitek, Mary Ellen, Henderson, William G, Huang, Grant D
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 08.01.2009
• Subjects: Biological and medical sciences; Blood Glucose - metabolism; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cardiovascular Diseases - prevention & control; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - epidemiology; Diabetic Angiopathies - prevention & control; Diabetic Neuropathies - epidemiology; Drug Therapy, Combination; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; General aspects; Glucose; Glycated Hemoglobin A - analysis; Humans; Hypoglycemic Agents - administration & dosage; Insulin; Insulin - administration & dosage; Kaplan-Meier Estimate; Male; Medical sciences; Metformin - administration & dosage; Middle Aged; Sulfonylurea Compounds - administration & dosage; Thiazolidinediones - administration & dosage; United States; Veterans; United States; North America; America; Endocrinopathy; Type 2 diabetes; Medicine; Blood vessel; Metabolic diseases; Complication; Veteran; Glycemia
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa0808431

In this study, 1791 military veterans with poorly controlled type 2 diabetes were randomly assigned to receive either standard or intensive glucose control. Other cardiovascular risk factors were treated uniformly. The glycated hemoglobin goal was an absolute reduction of 1.5 percentage points in the intensive-therapy group. There was no significant difference between the two groups for the rates of major cardiovascular events, death, or microvascular complications. In this study, military veterans with poorly controlled type 2 diabetes were randomly assigned to receive either standard or intensive glucose control. There was no significant difference between the two groups in the rates of major cardiovascular events, death, or microvascular complications. Several trials have shown that intensive glucose control in patients with type 2 diabetes mellitus reduces the progression of microvascular disease, 1 , 2 but the effect on macrovascular complications remains uncertain. In epidemiologic studies, the association between glucose control and cardiovascular disease has not been consistent. 3 – 6 Small short-term trials have suggested either benefit or adverse effects. 7 , 8 Two recent studies, the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial (ClinicalTrials.gov number, NCT00145925) 9 and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial (NCT00000620), 10 reported no significant decrease in cardiovascular events with intensive . . .