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Serum glucose control in diabetic patients with cardiovascular disease: should we be less aggressive?

Sunder Mudaliar1

  • 1VA San Diego Health Care System and Department of Medicine, University of California at San Diego, San Diego, CA 92161, USA. smudaliar@vapop.ucsd.edu

Current Atherosclerosis Reports
|August 12, 2009
PubMed

Insights

Aggressively controlling blood glucose in diabetes patients does not improve cardiovascular outcomes and may increase mortality. A glycated hemoglobin (HbA1c) target of 7% is recommended if achievable without adverse effects.

Area of Science:

  • Endocrinology
  • Cardiology
  • Diabetology

Background:

  • Hyperglycemia management in diabetes significantly reduces microvascular complications.
  • Evidence linking intensive glucose control to improved macrovascular cardiovascular disease (CVD) outcomes is lacking.
  • Recent studies indicate intensive blood glucose treatment may not impact CVD outcomes and could increase mortality.

Purpose of the Study:

  • To evaluate the impact of intensive glucose control on cardiovascular outcomes in diabetes patients.
  • To determine appropriate glycated hemoglobin (HbA1c) targets for different patient populations.
  • To emphasize the importance of managing other CVD risk factors.

Main Methods:

  • Review of recent studies on intensive blood glucose treatment and CVD outcomes.
  • Analysis of data regarding cardiovascular and all-cause mortality in relation to glycemic control.
  • Consideration of patient-specific factors like age, diabetes duration, comorbidities, and history of hypoglycemia.

Main Results:

  • Intensive blood glucose treatment shows no significant effect on CVD outcomes.
  • A potential paradoxical increase in cardiovascular and all-cause mortality observed, particularly in older patients with long-standing type 2 diabetes and pre-existing CVD.
  • A recommended glycated hemoglobin (HbA1c) target of 7% is prudent if achievable without hypoglycemia or adverse treatment effects.

Conclusions:

  • Aggressive hyperglycemia control does not clearly improve macrovascular CVD outcomes.
  • Individualized HbA1c goals are necessary, with less stringent targets for older patients or those with comorbidities.
  • Early diabetes treatment should include lifestyle modifications and aggressive management of cholesterol, blood pressure, and other CVD risk factors.

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