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



There are three limitations to this group of studies.

#1 - Type 1 and 2 are different animals.  This study only applies to Type 2,
and I am assuming most who frequent this site are Type 1's on pumps.  Although
clinically they appear similar, i.e. hyperglycemia, physiologically there are
major issues related to metabolic changes and hormonal changes associated with
insulin resistance that do not play major roles in Type I DM.  Don't assume
these results can be applied to Type I DM patients.

#2 - Both cardiovascular events and kidney events will kill.  Although the
general tone of the study is concerning the effect of tight glycemic control
upon the cardiovascular effects in older, cardiovascularly compromised, type 2
diabetic patients, don't lose the positive benefit in terms of kidney damage.
A 23% reduction in the incidence of nephropathies is significant enough to
justify the work required for tight control.

#3 - This study report cannot be applied with confidence to young, non-obese,
healthy heart and vessel patients.  The study was not powered for prediction
in other subgroups.

Jared

________________________________

From: email @ redacted on behalf of John S Wilkinson
Sent: Mon 6/9/2008 5:57 AM
To: email @ redacted
Subject: [IP] Intensive Glucose Control Does Not Prevent Major Cardiovascular
Events in Type 2 Diabetes



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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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