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Updated: Jun 13, 2026
10:03
A Zebrafish Model of Diabetes Mellitus and Metabolic Memory
Published on: February 28, 2013
[Hyperglycemia and cardiovascular risk: lessons from randomized trials].
1Service de diabétologie, métabolisme, groupe hospitalier La Pitié-Salpêtrière, AP-HP, 75651 Paris Cedex 13. andre.grimaldi@psl.aphp.fr
La Revue Du Praticien
|May 15, 2010
Summary
Achieving optimal blood sugar control in diabetes can reduce cardiovascular disease risk. However, intensive glucose lowering may increase mortality in patients with prior heart attacks, necessitating a balanced approach to glycemic targets.
Area of Science:
- Endocrinology
- Cardiology
- Metabolic Diseases
Context:
- Diabetes mellitus is a significant risk factor for cardiovascular disease (CVD).
- Hyperglycemia is strongly linked to microvascular complications but less so to macrovascular events.
- Epidemiological data suggest a 15% rise in myocardial infarction risk for every 1% increase in HbA1c.
Purpose:
- To evaluate the relationship between glycemic control and cardiovascular outcomes in diabetic patients.
- To determine the optimal HbA1c targets considering the risk of hypoglycemia, especially in patients with established CVD.
Summary:
- While good initial glycemic control offers long-term cardiovascular benefits, intensive glucose lowering (e.g., HbA1c < 6%) has not shown clear advantages and may increase mortality, particularly in patients with previous myocardial infarction (MI).
- Studies like ACCORD and VADT indicate increased cardiovascular mortality associated with severe hypoglycemia.
- Glycemic goals should be individualized, balancing the benefits of blood sugar reduction against the risks of hypoglycemia, especially in high-risk populations.
Impact:
- Individualized glycemic targets are crucial for diabetic patients with prior MI, modulating goals based on hypoglycemia risk.
- For patients on sulfonylureas or insulin with hypoglycemia risk, an HbA1c goal of 7.5% may be appropriate.
- A general HbA1c target of < 7% remains suitable, while < 6.5% is appropriate for those on insulin sensitizers without hypoglycemia risk.
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