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[IP] Intensive Glucose Control Does Not Prevent Major Cardiovascular Events in Type 2 Diabetes



Intensive Glucose Control Does Not Prevent Major Cardiovascular Events in
Type 2 Diabetes 


Intensive glucose control among adults with type 2 diabetes does not reduce
macrovascular events, according to two studies released online by the New
England Journal of Medicine.

In the ACCORD study, some 10,000 patients (mean age, 62) with type 2
diabetes and elevated cardiovascular risk were randomized to intensive
glucose lowering (target hemoglobin A1c, <6.0%) or standard therapy (target,
7.0-7.9%). Intensive treatment was stopped early, after 3.5 years, because
recipients showed significantly higher all-cause mortality than those on
standard therapy (5% vs. 4%). The primary endpoint - a composite of
myocardial infarction, stroke, and cardiovascular death - did not differ
between the groups.

In ADVANCE, researchers compared intensive gliclazide-based glucose control
(target hemoglobin, ?6.5%) with standard therapy among roughly 11,000 older
patients. After 5 years, intensive therapy showed no effect on macrovascular
events or all-cause mortality, although it did reduce nephropathy.

"These studies will cause a reexamination of guidelines and performance
measures," writes Harlan M. Krumholz in Journal Watch Cardiology. And in
Journal Watch General Medicine, Allan S. Brett concludes: "Aggressive
attempts to normalize HbA1c are not routinely warranted" in older diabetic
patients.

 
<http://click.jwatch.org/cts/click?q=227%3B66962339%3B2u5Ta6zVRgphLSfg8eRVDU
cELwldvpeJMUKjxXE56r0%3D> NEJM ACCORD study (Free)

 
<http://click.jwatch.org/cts/click?q=227%3B66962339%3B2u5Ta6zVRgphLSfg8eRVDS
Wu5PcbGWIuMUKjxXE56r0%3D> NEJM ADVANCE study (Free)

 
<http://click.jwatch.org/cts/click?q=227%3B66962339%3B2u5Ta6zVRgphLSfg8eRVDe
asHFiUJHCSMUKjxXE56r0%3D> NEJM editorial 1 (Free)

 
<http://click.jwatch.org/cts/click?q=227%3B66962339%3B2u5Ta6zVRgphLSfg8eRVDZ
V4JfNhha5uMUKjxXE56r0%3D> NEJM editorial 2 (Free)

 
<http://click.jwatch.org/cts/click?q=227%3B66962339%3B2u5Ta6zVRgphLSfg8eRVDe
KlXH%2BqaKJPMUKjxXE56r0%3D> NEJM perspective (Free)
.
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