Cited by 4,762Diabetes Treatment and ManagementDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

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Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes

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Abstract

BACKGROUND: The effects of intensive glucose control on cardiovascular events in patients with long-standing type 2 diabetes mellitus remain uncertain. METHODS: We randomly assigned 1791 military veterans (mean age, 60.4 years) who had a suboptimal response to therapy for type 2 diabetes to receive either intensive or standard glucose control. Other cardiovascular risk factors were treated uniformly. The mean number of years since the diagnosis of diabetes was 11.5, and 40% of the patients had already had a cardiovascular event. The goal in the intensive-therapy group was an absolute reduction of 1.5 percentage points in the glycated hemoglobin level, as compared with the standard-therapy group. The primary outcome was the time from randomization to the first occurrence of a major cardiovascular event, a composite of myocardial infarction, stroke, death from cardiovascular causes, congestive heart failure, surgery for vascular disease, inoperable coronary disease, and amputation for ischemic gangrene. RESULTS: The median follow-up was 5.6 years. Median glycated hemoglobin levels were 8.4% in the standard-therapy group and 6.9% in the intensive-therapy group. The primary outcome occurred in 264 patients in the standard-therapy group and 235 patients in the intensive-therapy group (hazard ratio in the intensive-therapy group, 0.88; 95% confidence interval [CI], 0.74 to 1.05; P=0.14). There was no significant difference between the two groups in any component of the primary outcome or in the rate of death from any cause (hazard ratio, 1.07; 95% CI, 0.81 to 1.42; P=0.62). No differences between the two groups were observed for microvascular complications. The rates of adverse events, predominantly hypoglycemia, were 17.6% in the standard-therapy group and 24.1% in the intensive-therapy group. CONCLUSIONS: Intensive glucose control in patients with poorly controlled type 2 diabetes had no significant effect on the rates of major cardiovascular events, death, or microvascular complications with the exception of progression of albuminuria (P = 0.01) [added]. (ClinicalTrials.gov number, NCT00032487.)

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  1. Shichiri M, 2000, Diabetes Care, 23, B21

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Metadata

Authors
Duckworth, W., Abraira, C., Moritz, T., Reda, D., Emanuele, N., Reaven, P. D., Zieve, F. J., Marks, J., Davis, S. N., Hayward, R., Warren, S. R., Goldman, S., McCarren, M., Vitek, M. E., Henderson, W. G., & Huang, G. D.
Affiliations
  • Phoenix VA Health Care System (US)
  • Miami VA Healthcare System (US)
  • Edward Hines, Jr. VA Hospital (US)
  • Hunter Holmes McGuire VA Medical Center (US)
  • VA Tennessee Valley Healthcare System (US)
  • VA Ann Arbor Healthcare System (US)
  • Southern Arizona VA Health Care System (US)
  • VA Office of Research and Development (US)
Venue
New England Journal of Medicine
Published
2009-01-08
Volume
360
Issue
2
Pages
129-139
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2158666727
Cited by
4,762
References
27
Citations by year
2026: 75 · 2025: 90 · 2024: 150 · 2023: 164 · 2022: 168 · 2021: 244 · 2020: 268 · 2019: 265 · 2018: 279 · 2017: 325 · 2016: 320 · 2015: 317 · 2014: 381 · 2013: 349 · 2012: 364
FWCI
239.94
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Diabetes Association
  • U.S. Department of Veterans Affairs
  • Eli Lilly and Company
  • Pfizer
  • Amylin Pharmaceuticals
  • GlaxoSmithKline
  • Sanofi
  • Office of Research and Development
  • MannKind Corporation
  • Novo Nordisk
  • National Eye Institute
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079637)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 2 diabetes, tight glycemic control, glycemic control, veterans, cardiovascular events, HbA1c, microvascular complications, albuminuria, hypoglycemia, cardiovascular mortality, long-standing diabetes
MeSH terms
Rosiglitazone, Blood Glucose, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Diabetic Neuropathies, Drug Therapy, Combination, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Male, Metformin, Middle Aged, Sulfonylurea Compounds, United States, Veterans, Thiazolidinediones, Kaplan-Meier Estimate

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