Intensive Glucose Control Does Not Prevent Major Cardiovascular Events in Type 2 Diabetes
Physician's First Watch for June 9, 2008
Intensive glucose control among adults with type 2 diabetes does not reduce macrovascular events, according to two studies released online by the New England Journal of Medicine.
In the ACCORD study, some 10,000 patients (mean age, 62) with type 2 diabetes and elevated cardiovascular risk were randomized to intensive glucose lowering (target hemoglobin A1c, <6.0%) or standard therapy (target, 7.0-7.9%). Intensive treatment was stopped early, after 3.5 years, because recipients showed significantly higher all-cause mortality than those on standard therapy (5% vs. 4%). The primary endpoint — a composite of myocardial infarction, stroke, and cardiovascular death — did not differ between the groups.
In ADVANCE, researchers compared intensive gliclazide-based glucose control (target hemoglobin, ≤6.5%) with standard therapy among roughly 11,000 older patients. After 5 years, intensive therapy showed no effect on macrovascular events or all-cause mortality, although it did reduce nephropathy.
These studies will cause a reexamination of guidelines and performance measures. Aggressive attempts to normalize HbA1c are not routinely warranted in older diabetic patients.