Current Atherosclerosis Reports

, Volume 11, Issue 5, pp 384–390 | Cite as

Serum glucose control in diabetic patients with cardiovascular disease: Should we be less aggressive?

Article
First Online:

Abstract

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.

Keywords

Severe Hypoglycemia United Kingdom Prospective Diabetes Study Intensive Glycemic Control Intensive Glucose Control Accord Study 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References and Recommended Reading

  1. 1.
    National Diabetes Information Clearinghouse: National Diabetes Statistics, 2007. Available at http://diabetes.niddk.nih.gov/DM/PUBS/statistics/. Accessed March 28, 2009.
  2. 2.
    International Diabetes Federation: Did You Know? Available at http://www.idf.org/home/index.cfm?node=37. Accessed March 28, 2009.
  3. 3.
    Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993, 329:977–986.CrossRefGoogle Scholar
  4. 4.
    UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998, 352:837–853.CrossRefGoogle Scholar
  5. 5.
    Selvin E, Marinopoulos S, Berkenblit G, et al.: Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004, 141:421–431PubMedGoogle Scholar
  6. 6.
    Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, et al.: Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008, 358:2545–2559.PubMedCrossRefGoogle Scholar
  7. 7.
    ADVANCE Collaborative Group, Patel A, MacMahon S, et al.: Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008, 358:2560–2572.PubMedCrossRefGoogle Scholar
  8. 8.
    Duckworth W, Abraira C, Moritz T, et al.; VADT Investigators: Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009, 360:129–139.PubMedCrossRefGoogle Scholar
  9. 9.
    Ohkubo Y, Kishikawa H, Araki E, et al.: Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract 1995, 28:103–117.PubMedCrossRefGoogle Scholar
  10. 10.
    Gaede P, Vedel P, Larsen N, et al.: Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003, 348:383–393.PubMedCrossRefGoogle Scholar
  11. 11.
    Nathan DM, Cleary PA, Backlund JY, et al.; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group: Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005, 353:2643–2653PubMedCrossRefGoogle Scholar
  12. 12.
    Stratton IM, Adler AI, Neil HA, et al.: Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000, 321:405–412.PubMedCrossRefGoogle Scholar
  13. 13.
    Cryer PE: Hypoglycemia: still the limiting factor in the glycemic management of diabetes. Endocr Pract 2008, 14:750–756.PubMedGoogle Scholar
  14. 14.
    Vinik AI, Maser RE, Mitchell BD, Freeman R: Diabetic autonomic neuropathy. Diabetes Care 2003, 26:1553–1579.PubMedCrossRefGoogle Scholar
  15. 15.
    Skyler JS, Bergenstal R, Bonow RO, et al.; American Diabetes Association; American College of Cardiology Foundation; American Heart Association: Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA Diabetes Trials: a position statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association. J Am Coll Cardiol 2009, 53:298–304.PubMedCrossRefGoogle Scholar
  16. 16.
    McFarlane SI, Banerji M, Sowers JR: Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab 2001, 86:713–718.PubMedCrossRefGoogle Scholar
  17. 17.
    Henry RR, Gumbiner B, Ditzler T, et al.: Intensive conventional insulin therapy for type II diabetes. Metabolic effects during a 6-mo outpatient trial. Diabetes Care 1993, 16:21–31.PubMedCrossRefGoogle Scholar
  18. 18.
    Nissen SE, Wolski K: Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 2007, 356:2457–2471. Erratum in N Engl J Med 2007, 357:100.PubMedCrossRefGoogle Scholar
  19. 19.
    Home PD, Pocock SJ, Beck-Nielsen H, et al.; RECORD Study Group: Rosiglitazone evaluated for cardiovascular outcomes-an interim analysis. N Engl J Med 2007, 357:28–38.PubMedCrossRefGoogle Scholar
  20. 20.
    Haffner SM, Stern MP, Hazuda HP, et al.: Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA 1990, 263:2893–2898.PubMedCrossRefGoogle Scholar
  21. 21.
    Holman RR, Paul SK, Bethel MA, et al.: 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008, 359:1577–1589.PubMedCrossRefGoogle Scholar
  22. 22.
    American Diabetes Association: Standards of medical care in diabetes-2009. Diabetes Care 2009, 32(Suppl 1):S13–S61.CrossRefGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.VA San Diego Health Care System and Department of MedicineUniversity of California at San DiegoSan DiegoUSA

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