Glycaemic separation and risk factor control in the Veterans Affairs Diabetes Trial: an interim report
Abstract
Objective: The Veterans Affairs Diabetes Trial (VADT) will assess the effect of intensive (INT) vs improved standard (STD) glycaemic control on major cardiovascular (CV) events, treating other risk factors equally in both arms. Four‐year results of main metabolic parameters are presented. Research design and methods: VADT is a 7.5 years prospective randomized study of 1791 patients, 20 centres, of men and women of age 60.5 ± 8.7 years, diagnosed for 11.5 ± 7.5 years. Their body mass index (BMI) at baseline was 31 ± 4 kg/m 2 and mean A1C 9.4 ± 1.5% after maximum dose of oral agents or insulin treatment. Step treatment consists of glimepiride or metformin, rosiglitazone, insulin and other agents; A1C goals are 8–9% in STD and <6% in INT. Lifestyle, blood pressure and lipids are treated uniformly in both arms. Results: A1C improved in both arms. INT kept median A1C <7% all years, A1C separation is 1.5–1.7%. From year 1 to 4, mean blood pressure is <129/74 mmHg, similar throughout. Median LDL‐C was <97 mg/dl by year 1 and triglycerides 150 or less by 2 years. Triglycerides were lower in INT (12–16 mg/dl; p < 0.01). By 4 years, 88% are on lipid‐lowering agents and 93% are on antiplatelet/anticoagulant agents. BMI is higher in INT every year (0.9–1.6 kg/m 2 ; p < 0.01). Conclusion: VADT is maintaining the expected A1C in both STD and INT, and LDL‐C, triglycerides and blood pressure are at target. The trial is continuing to June 2008. It will be the first long‐term completed type 2 diabetes study of the role of glycaemia on CV disease with modern treatments.
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Current studies have failed to demonstrate a beneficial effect of intensive diabetes therapy on cardiovascular disease in type 2 diabetes.
“current studies have failed to demonstrate a beneficial effect of intensive diabetes therapy on CVD in type 2 diabetes (11–13)”
From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [13]
The ADVANCE trial and the Veterans Affairs Diabetes Trial did not demonstrate any excess total or cardiovascular disease mortality with intensive regimens that achieved A1C levels comparable with the 6.5% in ACCORD.
“Results from the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial and the Veterans Affairs Diabetes Trial, both of which had different interventions and study populations than ACCORD, did not demonstrate any excess total or CVD mortality with intensive regimens that achieved A1C levels comparable with the 6.5% in ACCORD (12,13).”
From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [13]
None of the studies has demonstrated a benefit of intensive glycemic control on their primary cardiovascular disease outcomes.
“However, none of the studies has demonstrated a benefit of intensive glycemic control on their primary CVD outcomes.”
From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [13]
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Glucose control and vascular complications in veterans with type 2 diabetes
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Self-citation
- Authors
- Abraira, C., Duckworth, W. C., & Moritz, T.
- Affiliations
- United States Department of Veterans Affairs (US)
- Veterans Health Administration (US)
- Edward Hines, Jr. VA Hospital (US)
- Corresponding author
- Abraira, C.
- ORCID
- Moritz, T.
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2008-12-29
- Volume
- 11
- Issue
- 2
- Pages
- 150-156
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- OpenAlex
- W2066941565
- Cited by
- 51
- References
- 29
- Citations by year
- 2023: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2017: 1 · 2016: 3 · 2015: 3 · 2014: 4 · 2013: 7 · 2012: 2
- FWCI
- 6.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- 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, HbA1c, cardiovascular risk factors, LDL cholesterol, triglycerides, blood pressure, body mass index, rosiglitazone, metformin, glimepiride, insulin, lipid-lowering drugs, antiplatelet therapy, cardiovascular disease
- MeSH terms
- Aged, Blood Glucose, Body Weight, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Male, Middle Aged, Prospective Studies, Risk Factors, Veterans, Body Mass Index
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