Update in diabetes and cardiovascular disease: synthesizing the evidence from recent trials of glycemic control to prevent cardiovascular disease.
Open accessAbstract
PURPOSE OF REVIEW: To review the recent studies on intensive glucose control and the risk of cardiovascular disease (CVD) in type 2 diabetes, to discuss potential reasons for discordant results among recent trials, and to comment on implications for clinical practice. RECENT FINDINGS: Three large randomized controlled trials on the effect of tight glycemic control (TGC) on CVD in patients with type 2 diabetes have been published within the last year, along with the cardiovascular outcomes from the long-term follow-up of the United Kingdom Prospective Diabetes study. This narrative review of the methods and results of these trials reveals cardiovascular benefit from early institution of TGC, and lack of benefit or potential harm with intensification of glucose control late in the course of type 2 diabetes or after CVD has developed. Also, the benefits of TGC may be outweighed by weight gain and hypoglycemia. All trials had fewer cardiovascular events than anticipated, likely due to improvements in treatment of other cardiovascular risk factors. SUMMARY: In addition to controlling cardiovascular risk factors, patients with type 2 diabetes should aim for good glycemic control (HbA1c<7%) soon after the diagnosis of diabetes to prevent macrovascular as well as microvascular complications. Glycemic targets should be individualized as diabetes progresses, comorbidities develop, and to avoid having the side-effects of therapy (hypoglycemia and weight gain) predominate.
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- [22]New Analyses Shed Further Light On VADT and ACCORD Trial Results ADA 69th Scientific Sessions 2009 New Orleans ADA 1 6 Summary of symposium during the ADA 69th Scientific Sessions regarding VADT and ACCORD, where new analyses for VADT were presented that showed TGC instituted within 15 years of the diagnosis of diabetes reduced the risk of CVD and mortality, but TGC instituted 16–20 years after the diagnosis yielded no benefit, and TGC instituted >20 years of diagnosis increased risk of CV events. Also, new ACCORD analysis was presented that did not support the conclusion that low HbA1c levels were the cause of the increased mortality during the trial.
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- Authors
- Park, L., & Wexler, D.
- Affiliations
- Newton Wellesley Hospital (US)
- Harvard University (US)
- Corresponding author
- Wexler, Deborah
- ORCID
- Wexler, Deborah
- Venue
- Current Opinion in Lipidology
- Published
- 2010-02
- Volume
- 21
- Issue
- 1
- Pages
- 8-14
- ISSN
- 0957-9672 (ISSN-L)
- PMC
- PMC2871337
- OpenAlex
- W2031648155
- Cited by
- 9
- References
- 29
- Citations by year
- 2026: 1 · 2025: 1 · 2014: 4 · 2012: 1
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Opinion in Lipidology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5k23dk080228-04)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23-DK-080228)
- 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, cardiovascular disease, tight glycemic control, HbA1c targets, cardiovascular risk factors, UKPDS, randomized controlled trials, hypoglycemia, weight gain, individualized glycemic targets, macrovascular complications, microvascular complications
- MeSH terms
- Blood Glucose, Cardiovascular Diseases, Clinical Trials as Topic, Diabetes Mellitus, Type 2, Humans
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