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Long-term effects of intensive glucose lowering on cardiovascular outcomes

, Hertzel C Gerstein, Michael E Miller

    The New England Journal of Medicine
    |March 4, 2011
    PubMed

    Insights

    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.
    Abstract

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