Intensive glucose control shown to have no effect on the rates of major vascular complications in type 2 diabetes
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The degree to which intensive glucose lowering with parmacotherapy affects macrovascular outcomes remains a matter of uncertainty. To investigate the effects of intensive glucose control on cardiovascular events in patients with long-standing type 2 diabetes mellitus, 1791 military veterans (of whom 60% were in primary cardiovascular prevention) with suboptimal response to therapy for type 2 diabetes were randomly assigned to receive either intensive or standard glucose control. The primary outcome was the time from randomization to the first occurrence of a major cardiovascular event. Following a median follow-up of 5.6 years, median glycated haemoglobin levels were 8.4% in the standard-therapy group and 6.9% in the intensive-therapy group. There was no significant between-group difference in any component of the primary outcome, in the rate of death from any cause or in microvascular complications. The rates of adverse events (mostly hypoglycaemia) were 37% higher in the intensive-therapy group. Intensive glucose control in patients with poorly controlled type 2 diabetes and in both primary and secondary cardiovascular prevention had no significant effect on the rates of major cardiovascular events, death, or microvascular complications.
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