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Implications of new diabetes treatment trials: should current clinical practice be altered?

Jeffrey D Kravetz1, Daniel G Federman

  • 1VA Connecticut Health Care, 950 Campbell Avenue, West Haven, CT 06516, USA. jeffrey.kravetz@va.gov

Postgraduate Medicine
|June 4, 2009
PubMed

Insights

Intensive glycemic control in type 2 diabetes mellitus (T2DM) did not significantly reduce macrovascular events in major trials like ACCORD, ADVANCE, and VADT. These findings emphasize careful consideration of intensive glucose lowering in T2DM patients.

Area of Science:

  • Endocrinology
  • Cardiology
  • Clinical Trials

Background:

  • Type 2 diabetes mellitus (T2DM) patients face elevated risks for microvascular and macrovascular complications.
  • While glycemic control benefits microvascular outcomes, its impact on macrovascular events remains debated.

Purpose of the Study:

  • To compare three major randomized controlled trials (ACCORD, ADVANCE, VADT) assessing intensive glucose-lowering strategies in T2DM.
  • To analyze the effects of intensive glycemic control on macrovascular outcomes, including myocardial infarction, stroke, and death.

Main Methods:

  • Review and comparison of the methodologies, patient populations, and interventions of the ACCORD, ADVANCE, and VADT trials.
  • Analysis of reported outcomes related to macrovascular events and mortality across the three studies.

Main Results:

  • Intensive glycemic control did not consistently demonstrate a significant reduction in major macrovascular events (myocardial infarction, stroke, death) across the trials.
  • Some trials showed potential increases in adverse events with intensive glucose lowering, necessitating careful risk-benefit assessment.

Conclusions:

  • Intensive glucose-lowering strategies in T2DM, as evaluated in ACCORD, ADVANCE, and VADT, do not offer clear macrovascular benefits and may carry risks.
  • Patient care decisions regarding intensive glycemic control should consider individual risk factors and potential adverse effects.

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