Study redeems tight glucose control

After being called into question by two large studies earlier this year, the benefits of intensive glycemic control in type 2 diabetes recently got some support from another long-term trial.

Researchers conducted post-trial monitoring on 4,209 patients who had newly diagnosed type 2 diabetes when they entered the United Kingdom Prospective Diabetes Study (UKPDS). Those who underwent intensive glucose therapy during the study had a lower risk of microvascular complications. Investigators sought to determine the long-term persistence and effects of this early glucose control.

During 10 years of post-trial follow-up, researchers observed a continued reduction in microvascular risk and emerging reductions in heart attack and death from any cause. “Although the UKPDS conclusively showed the benefit of improved glycemic control in reducing the risk of microvascular disease, risk reductions for MI and death from any cause were observed only with extended post-trial follow-up,” the investigators noted (N Engl J Med. 2008;359:1577-1589).

Earlier this year, the ACCORD and ADVANCE studies involving more than 21,000 people with type 2 diabetes observed only nonsignificant reductions in major macrovascular events following intensive glucose-lowering therapy. But those patients were older and at greater risk than the UKPDS patients, and they had been treated for several years prior to study enrollment (unlike the UKPDS individuals who underwent intensive glucose therapy soon after their diagnosis). Also, the ACCORD and ADVANCE findings were based on shorter follow-up periods of 3.5 and 5 years, respectively (ACCORD's intensive-glucose-lowering arm was halted in February 2008 due to an unexplained excess rate of death from any cause).
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