NEJM: Intensive glucose control fails to reduce cardiovascular events
Intensive glucose control in patients with poorly controlled type 2 diabetes had no significant effect on the rates of major cardiovascular events, death or microvascular complications, according to a study in the Dec. 17 issue of the New England Journal of Medicine.

William Duckworth, MD, from the Phoenix Veterans Affairs Health Care Center in Phoenix, and colleagues randomly assigned 1791 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. They treated cardiovascular risk factors uniformly.

The authors said that the mean number of years since the diagnosis of diabetes was 11.5, and 40 percent of the patients had already had a cardiovascular 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 primary outcome was the time from randomization to the first occurrence of a cardiovascular event, a composite of MI, stroke, death from cardiovascular causes, congestive heart failure, surgery for vascular disease, inoperable coronary disease and amputation for ischemic gangrene.

The median follow-up was 5.6 years. 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.

The researchers said that there was 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 noted 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.”