Cutting heart risk with tight glucose control

Intensive treatment to lower glucose levels in patients with type 2 diabetes does appear to significantly reduce coronary events without increasing the risk of death. This finding supports reports that were called into question last year by outcomes in three large studies—ACCORD, ADVANCE, and the Veterans Affairs Diabetes Trial.

Researchers looked at the effectiveness of intensive and standard glucose-lowering regimens in reducing mortality and cardiovascular (CV) outcomes in people with type 2 diabetes (Lancet. 2009;373:1765-1772). Investigators reviewed five prospective, randomized controlled trials. Findings from some of these trials cast doubt on the presumed value of intensive glucose control in the prevention of CV problems in type 2 disease.

The five studies included in the analysis involved 33,040 participants and provided information on 1,497 events of nonfatal MI; 2,318 events of coronary heart disease (CHD); 1,127 events of stroke; and 2,892 events of all-cause mortality during approximately 163,000 person-years of follow-up.

Hemoglobin A1c was an average 0.9% lower in the intensive-treatment participants than in those receiving standard treatment. Although intensive glycemic control had no significant effect on events of stroke or all-cause mortality, it did reduce nonfatal MI events by 17% and events of CHD by 15% during approximately five years of treatment.

"Our findings provide reassurance about the effectiveness of [glycemic] control for CV risk reduction, but we have not proven a clear benefit to all-cause mortality," the team of investigators reports. "By contrast, strong evidence suggests that lipid-lowering treatment and BP reduction does benefit all-cause mortality reduction, which reinforces the crucial importance of these treatments to reduce CV events and all-cause mortality in individuals with type 2 diabetes."
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