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Glycemic control and cardiovascular disease: what's a doctor to do?

Preeti Kishore1, Sharon H Kim, Jill P Crandall

  • 1Division of Endocrinology and Diabetes Research Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.

Current Diabetes Reports
|April 3, 2012
PubMed

Insights

Intensive glycemic control in type 2 diabetes does not reduce cardiovascular disease (CVD) risk or mortality. Some studies even showed increased mortality with intensive control, challenging previous assumptions.

Area of Science:

  • Endocrinology
  • Cardiology
  • Clinical Trials

Background:

  • Cardiovascular disease (CVD) is the primary cause of death in diabetes mellitus patients.
  • Diabetes patients have a 2-4 times higher CVD mortality rate compared to non-diabetics.
  • Near-normal blood sugar levels were previously thought to reduce CVD risk and mortality in type 2 diabetes.

Purpose of the Study:

  • To review major clinical trials investigating intensive glycemic control in type 2 diabetes.
  • To explore reasons for the unexpected negative results in these trials.
  • To provide clinical management insights for diabetic patients.

Main Methods:

  • Review of several large randomized control trials.
  • Comparison of intensive glycemic control versus conventional therapy arms.
  • Analysis of mortality and CVD event data.

Main Results:

  • Intensive glycemic control did not show a significant advantage in reducing mortality or CVD events.
  • Some trials, like ACCORD, indicated increased mortality in the intensive control group.
  • The conventional approach to glycemic control may be more appropriate for reducing CVD risk.

Conclusions:

  • Intensive glycemic control strategies do not improve outcomes for type 2 diabetes patients regarding CVD.
  • Potential risks associated with intensive control need careful consideration.
  • Clinical practice should be guided by trial evidence, focusing on individualized patient care.

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