NEJM: Intensive glucose control does not reduce CV events in diabetic patients

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Intensive glucose control in patients with poorly controlled type 2 diabetes had no significant effect on the rates of major cardiovascular (CV) events, death or microvascular complications, according to a study in the Jan. 8 issue of the New England Journal of Medicine.

William Duckworth, MD, from the Phoenix Veterans Affairs Health Care System in Phoenix, and colleagues randomly assigned 1,791 military veterans (mean age, 60.4 years) who had a suboptimal response to therapy for type 2 diabetes to receive either intensive or standard glucose control. Other CV risk factors were treated uniformly. The mean number of years since the diagnosis of diabetes was 11.5 and 40 percent of the patients had already had a CV event. The goal in the intensive-therapy group was an absolute reduction of 1.5 percentage points in the glycated hemoglobin level, as compared with the standard-therapy group.

The researchers said that the primary outcome was the time from randomization to the first occurrence of a major CV event, a composite of MI, stroke, death from CV causes, congestive heart failure, surgery for vascular disease, inoperable coronary disease and amputation for ischemic gangrene. The median follow-up was 5.6 years.

The investigators found that the median glycated hemoglobin levels were 8.4 percent in the standard-therapy group and 6.9 percent in the intensive-therapy group.

Duckworth and colleagues found that the primary outcome occurred in 264 patients in the standard-therapy group and 235 patients in the intensive-therapy group. There was no significant difference between the two groups in any component of the primary outcome or in the rate of death from any cause. No differences between the two groups were observed for microvascular complications. The rates of adverse events, predominantly hypoglycemia, were 17.6 percent in the standard-therapy group and 24.1 percent in the intensive-therapy group.

The authors concluded that their “study, along with the ADVANCE and ACCORD studies, examined different populations with different approaches and came to similar conclusions. Intensive glucose control did not reduce cardiovascular events in patients with previously diagnosed type 2 diabetes.”