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Published on: February 28, 2013

Diabetes and cardiovascular disease: the role of glycemic control

Alice Y Y Cheng1, Lawrence A Leiter

  • 1St. Michael's Hospital, 6121-61 Queen Street East, Toronto, Ontario M5C 2T2, Canada.

Current Diabetes Reports
|February 5, 2009
PubMed

Insights

Intensive glycemic control (HbA1c < 6%) does not reduce cardiovascular risk in high-risk type 2 diabetes patients. Early intervention may offer long-term benefits, supporting an HbA1c target of < 7%.

Area of Science:

  • Endocrinology
  • Cardiovascular Medicine
  • Diabetes Research

Background:

  • Recent clinical guidelines recommended lower glycemic targets for type 2 diabetes.
  • Intensive glycemic control aims to reduce diabetes-related complications.

Purpose of the Study:

  • To evaluate the cardiovascular risk associated with intensive glycemic targets in type 2 diabetes.
  • To determine optimal hemoglobin A1c targets for managing type 2 diabetes.

Main Methods:

  • Analysis of recent randomized controlled trials (ACCORD, ADVANCE, VADT) and UKPDS post-trial monitoring.
  • Assessment of cardiovascular outcomes in relation to glycemic control strategies.

Main Results:

  • Intensive glycemic targets (HbA1c < 6%) did not reduce cardiovascular risk in high-risk individuals over 3.5-5 years.
  • UKPDS showed long-term cardiovascular benefits from early intensive glycemic control (median 17 years).

Conclusions:

  • A hemoglobin A1c target below 6% is not recommended for high-risk type 2 diabetes patients.
  • An HbA1c target below 7% is supported for reducing microvascular and potentially macrovascular complications, especially with early intervention.

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