Current Atherosclerosis Reports

, Volume 11, Issue 5, pp 384–390

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



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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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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