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Long-term effects of intensive glucose lowering on cardiovascular outcomes
The New England Journal of Medicine
|March 4, 2011
Summary
Intensive glucose lowering in type 2 diabetes patients with cardiovascular disease increased mortality and nonfatal myocardial infarctions. This strategy is not recommended for high-risk individuals.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Trials
Background:
- Intensive glucose lowering can increase mortality in type 2 diabetes patients with advanced disease and high cardiovascular risk.
- This study reports 5-year outcomes following intensive glucose lowering interventions.
Purpose of the Study:
- To evaluate the 5-year outcomes of intensive versus standard glucose lowering therapy on mortality and cardiovascular events in high-risk type 2 diabetes patients.
Main Methods:
- Randomized assignment of participants with type 2 diabetes and cardiovascular disease or risk factors to intensive (HbA1c < 6.0%) or standard (HbA1c 7.0-7.9%) therapy.
- Intensive therapy was terminated early due to increased mortality; all participants were then targeted for HbA1c 7.0-7.9% and followed for 5 years.
Main Results:
- Intensive therapy (3.7 years) did not significantly differ in primary composite cardiovascular outcomes but showed increased all-cause mortality (HR 1.19; 95% CI, 1.03-1.38).
- A reduction in nonfatal myocardial infarctions was observed with intensive therapy (HR 0.82; 95% CI, 0.70-0.96).
- Post-termination, HbA1c levels normalized between groups, with similar adverse event rates.
Conclusions:
- Intensive glucose lowering (HbA1c < 6%) for 3.7 years reduced nonfatal myocardial infarctions but increased 5-year mortality in high-risk type 2 diabetes patients.
- This intensive glucose-lowering strategy is not recommended for patients with advanced type 2 diabetes and high cardiovascular risk.
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