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Current Cardiology Reports

, Volume 14, Issue 1, pp 79–88 | Cite as

Does Aggressive Glycemic Control Benefit Macrovascular and Microvascular Disease in Type 2 Diabetes?: Insights from ACCORD, ADVANCE, and VADT

  • Toni TerryEmail author
  • Kalyani Raravikar
  • Nalurporn Chokrungvaranon
  • Peter D. Reaven
Diabetes and Cardiovascular Disease (ND Wong, Section Editor)

Abstract

Diabetes is increasing rapidly worldwide and frequently results in severe vascular complications. A target glycated hemoglobin of less than 7% has commonly been recommended in hopes of preventing both macrovascular and microvascular complications. Although results from trials of intensive glycemic control have generally supported the notion that lower glycated hemoglobin values reduce microvascular disease, the evidence for similar benefits for macrovascular disease has been less clear. As macrovascular disease is the major cause of morbidity and mortality in type 2 diabetes, this remains one of the more important unresolved clinical questions. Recent results from the ACCORD, ADVANCE, and VADT studies have challenged the conventional believe that lower glycated hemoglobin values should be pursued in all diabetic patients. Factors that may influence whether intensive glucose management is advisable include duration of diabetes, pre-existing macrovascular disease, hypoglycemic unawareness, and significant comorbidities. Glycated hemoglobin goals should account for these factors and be individualized for each patient.

Keywords

Type 2 diabetes Macrovascular disease Microvascular disease Intensive glycemic control UGDP UKPDS ACCORD ADVANCE VADT Coronary artery calcium Atherosclerosis Diabetes duration Hypoglycemic unawareness Glycated hemoglobin Advanced glycation end products Metabolic memory 

Clinical Trial Acronyms

ACCORD

Action to Control Cardiovascular Risk in Diabetes

ADVANCE

Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation

DCCT

Diabetes Control and Complications Trial

UGDP

University Group Diabetes Program

UKPDS

United Kingdom Prospective Diabetes Study

VADT

Veterans Affairs Diabetes Trial

Notes

Disclosure

Conflicts of interest: T. Terry: none; K. Raravikar: none; N. Chokrungvaranon: none; P. Reaven: has received grant support from Amylin and Takada.

Disclaimer

This material is based upon work supported in part by the Department of Veterans Affairs Cooperative Studies Program. The contents do not represent the views of the Department of Veterans Affairs or the United States Government.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Toni Terry
    • 1
    Email author
  • Kalyani Raravikar
    • 2
  • Nalurporn Chokrungvaranon
    • 3
  • Peter D. Reaven
    • 1
    • 4
    • 5
  1. 1.Division of EndocrinologyPhoenix VA Health Care SystemPhoenixUSA
  2. 2.Research Department, Endocrine SectionPhoenix VA Health Care SystemPhoenixUSA
  3. 3.EndocrinologyUniversity of Missouri Kansas CityKansas CityUSA
  4. 4.Arizona State UniversityTempeUSA
  5. 5.University of ArizonaPhoenixUSA

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