Serum glucose control in diabetic patients with cardiovascular disease: Should we be less aggressive?
- Sunder Mudaliar
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Although aggressive control of hyperglycemia significantly reduces microvascular complications in patients with diabetes, there is no clear evidence that it improves macrovascular cardiovascular disease (CVD) outcomes. Data from recent studies suggest that intensive treatment of blood glucose has no significant effect on CVD outcomes and may even paradoxically increase cardiovascular and all-cause mortality, especially in older patients with longstanding type 2 diabetes and preexisting CVD. At present, it is prudent to aim for a glycated hemoglobin (HbA1c) target of 7%, provided this can be achieved without hypoglycemia and other adverse effects of antidiabetic treatment. Treatment of patients with diabetes should begin early and include intensive efforts to promote a healthy lifestyle. Less stringent HbA1c goals may be appropriate in older patients with advanced microvascular and macrovascular disease, other comorbid conditions, and a history of severe hypoglycemia. At all times, cholesterol, blood pressure, and other CVD risk factors should be aggressively managed.
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- Serum glucose control in diabetic patients with cardiovascular disease: Should we be less aggressive?
Current Atherosclerosis Reports
Volume 11, Issue 5 , pp 384-390
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- Sunder Mudaliar (1)
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- 1. VA San Diego Health Care System and Department of Medicine, University of California at San Diego, 3350 La Jolla Village Drive, Mail Code: 111G, San Diego, CA, 92161, USA