Glucose control and vascular complications in veterans with type 2 diabetes
William Duckworth, Carlos Abraira, Thomas Moritz, Domenic Reda, Nicholas Emanuele, Peter D Reaven, Franklin J Zieve, Jennifer Marks, Stephen N Davis, Rodney Hayward, Stuart R Warren, Steven Goldman, Madeline McCarren, Mary Ellen Vitek, William G Henderson, Grant D Huang, VADT Investigators, C Abraira, W C Duckworth, C Paul, D Arca, L Cason, R Martinez Zolotor, L Williams, S L Collier, N Ahmed, A Boyd, D Reda, T Moritz, R Anderson, M E Vitek, T Paine, L Thottapurathu, P Luo, K Bukowski, D Motyka, V Barillas, R Brown, B Christine, L Anfinsen, M Biondic, R Havlicek, J Kubal, M McAuliffe, M McCarren, M Rachelle, L Rose, J Sacks, T Sindowski, J Thomas, C Zahora, M R Sather, S Warren, J Day, J Haroldson, C Abraira, W Duckworth, S N Davis, N Emanuele, S Goldman, R Hayward, J Marks, T Moritz, P Reaven, D Reda, S Warren, F Zieve, W Wendell, J Haroldson, P Harper, W G Henderson, R R Henry, M S Kirkman, M McCarren, J Sacks, J Gavin, E Chew, B Howard, T Karrison, I V Pacold, D Seigel, F Vinicor, B Massie, S Goldman, S Rapcsak, G Sethi, M Sharon, H Thai, K Zadina, J Christensen, D Morrison, P Spooner, A Westerband, B Materson, E Brinton, R Klein, J A Colwell, E J Schaefer, C S Gass, D A Ehrmann, P Rue, E J Schaefer, J R McNamara, M Brophy, D Humphries, D Govan, L McDonnell, L Carlton, Y Weng, R A Hayward, S Krein, S Goldman, K Zadina, M Davis, K Glander, J Soule, S Caulder, C Pittman, O Alston, R K Mayfield, G Moffitt, J Sagel, F Sanacor, E Ganaway, J Marks, L Okur, L Jones, H Florez, D Pfeifer, L Samos, A L Taylor, M B Zimering, A Sama, F Rosenberg, H Garcia, N Ertel, L Pogach, J J Shin, F Caldarella, C Carseli, M Shah, P Ginier, G Arakel, Y Fu, D Tayloe, J E Allen, E Fox, P G Hensley, N Emanuele, K Kahsen, P Linnerud, L Agrawal, N Azad, M Marcelli, G R Cunningham, N M Nichols, E Cordero, R Hijazi, F Roman, P Datta, M Garcia Touza, A Lteif, K L Moore, C Lazar-Robinson, S Gupta, M S Kirkman, M Mendez, Z Haider, L Risley, D Karounos, L Barber, J Hibbard, J W Anderson, L R Reynolds, J Carlsen, R W Collins, A Ehtisham, M L Kashyap, B Matheus, T Rahbarnia, A N Vo, N Downey, L Fox, R M Gonzales, C D Meyers, S Tavintharan, F Q Nuttall, L Cupersmith, K Dardick, L Kollman, A Georgopoulos, C Niewoehner, S N Davis, P Harper, D Davis, J Devin, A Marney, J Passyn-Dunn, J Perkins, J Stafford, A Powers, L Balch, P Harris, R J Anderson, D Dunning, S Ludwig, M Vogel, C DeSouza, R Ecklund, S Doran, C Korolchuk, M McElmeel, S Wagstaff, P Reaven, B Solie, J Matchette, C Meyer, S Vela, N Aslam, E Brinton, J Clark, A Domb, L McDonald, L Shurtz, R H Rao, J N Beattie, C Franko, F R DeRubertis, D Kelly, M Maser, J Paul, F Zieve, S J Clark, A Grimsdale, S Fredrickson, J Levy, D Schroeder, A Iranmanesh, B Dunn, D Arsura, C Kovesdy, S Hanna, A Iranmanesh, C Florow, F Remandaban, E Smith, R R Henry, M Keller, V Aroda, C Choe, S Edelman, A Gasper, D MaFong, S Mudaliar, D Oh, R Bandukwala, A Chang, S Chaudhary, S Chinnapongse, L Christiansen, N Chu, D Kim, M Lupo, C Manju, R Plodkowski, R Sathyaprakash, J Wilson, J Yu, G Macaraeg, S Tornes, R DeFronzo, L Johnson, K Cusi, D Tripathy, M Bajaj, J Blodgett, S Kayshup, M H Vasquez, B Walz, T Weaver, J Benabe, Z Mercado, B Padilla, J Serrano-Rodriguez, C Rosado, E Mejias, T Tejera, C Geldrez, E Gonzalez-Melendez, M Natal, M Rios Jimenez, J H Shah, W S Wendel, L Scott, L A Gurnsey, F A Kwiecinski, T Boyden, M G Goldschmid, V Easton, William Duckworth, Carlos Abraira, Thomas Moritz, Domenic Reda, Nicholas Emanuele, Peter D Reaven, Franklin J Zieve, Jennifer Marks, Stephen N Davis, Rodney Hayward, Stuart R Warren, Steven Goldman, Madeline McCarren, Mary Ellen Vitek, William G Henderson, Grant D Huang, VADT Investigators, C Abraira, W C Duckworth, C Paul, D Arca, L Cason, R Martinez Zolotor, L Williams, S L Collier, N Ahmed, A Boyd, D Reda, T Moritz, R Anderson, M E Vitek, T Paine, L Thottapurathu, P Luo, K Bukowski, D Motyka, V Barillas, R Brown, B Christine, L Anfinsen, M Biondic, R Havlicek, J Kubal, M McAuliffe, M McCarren, M Rachelle, L Rose, J Sacks, T Sindowski, J Thomas, C Zahora, M R Sather, S Warren, J Day, J Haroldson, C Abraira, W Duckworth, S N Davis, N Emanuele, S Goldman, R Hayward, J Marks, T Moritz, P Reaven, D Reda, S Warren, F Zieve, W Wendell, J Haroldson, P Harper, W G Henderson, R R Henry, M S Kirkman, M McCarren, J Sacks, J Gavin, E Chew, B Howard, T Karrison, I V Pacold, D Seigel, F Vinicor, B Massie, S Goldman, S Rapcsak, G Sethi, M Sharon, H Thai, K Zadina, J Christensen, D Morrison, P Spooner, A Westerband, B Materson, E Brinton, R Klein, J A Colwell, E J Schaefer, C S Gass, D A Ehrmann, P Rue, E J Schaefer, J R McNamara, M Brophy, D Humphries, D Govan, L McDonnell, L Carlton, Y Weng, R A Hayward, S Krein, S Goldman, K Zadina, M Davis, K Glander, J Soule, S Caulder, C Pittman, O Alston, R K Mayfield, G Moffitt, J Sagel, F Sanacor, E Ganaway, J Marks, L Okur, L Jones, H Florez, D Pfeifer, L Samos, A L Taylor, M B Zimering, A Sama, F Rosenberg, H Garcia, N Ertel, L Pogach, J J Shin, F Caldarella, C Carseli, M Shah, P Ginier, G Arakel, Y Fu, D Tayloe, J E Allen, E Fox, P G Hensley, N Emanuele, K Kahsen, P Linnerud, L Agrawal, N Azad, M Marcelli, G R Cunningham, N M Nichols, E Cordero, R Hijazi, F Roman, P Datta, M Garcia Touza, A Lteif, K L Moore, C Lazar-Robinson, S Gupta, M S Kirkman, M Mendez, Z Haider, L Risley, D Karounos, L Barber, J Hibbard, J W Anderson, L R Reynolds, J Carlsen, R W Collins, A Ehtisham, M L Kashyap, B Matheus, T Rahbarnia, A N Vo, N Downey, L Fox, R M Gonzales, C D Meyers, S Tavintharan, F Q Nuttall, L Cupersmith, K Dardick, L Kollman, A Georgopoulos, C Niewoehner, S N Davis, P Harper, D Davis, J Devin, A Marney, J Passyn-Dunn, J Perkins, J Stafford, A Powers, L Balch, P Harris, R J Anderson, D Dunning, S Ludwig, M Vogel, C DeSouza, R Ecklund, S Doran, C Korolchuk, M McElmeel, S Wagstaff, P Reaven, B Solie, J Matchette, C Meyer, S Vela, N Aslam, E Brinton, J Clark, A Domb, L McDonald, L Shurtz, R H Rao, J N Beattie, C Franko, F R DeRubertis, D Kelly, M Maser, J Paul, F Zieve, S J Clark, A Grimsdale, S Fredrickson, J Levy, D Schroeder, A Iranmanesh, B Dunn, D Arsura, C Kovesdy, S Hanna, A Iranmanesh, C Florow, F Remandaban, E Smith, R R Henry, M Keller, V Aroda, C Choe, S Edelman, A Gasper, D MaFong, S Mudaliar, D Oh, R Bandukwala, A Chang, S Chaudhary, S Chinnapongse, L Christiansen, N Chu, D Kim, M Lupo, C Manju, R Plodkowski, R Sathyaprakash, J Wilson, J Yu, G Macaraeg, S Tornes, R DeFronzo, L Johnson, K Cusi, D Tripathy, M Bajaj, J Blodgett, S Kayshup, M H Vasquez, B Walz, T Weaver, J Benabe, Z Mercado, B Padilla, J Serrano-Rodriguez, C Rosado, E Mejias, T Tejera, C Geldrez, E Gonzalez-Melendez, M Natal, M Rios Jimenez, J H Shah, W S Wendel, L Scott, L A Gurnsey, F A Kwiecinski, T Boyden, M G Goldschmid, V Easton
Abstract
Background: The effects of intensive glucose control on cardiovascular events in patients with long-standing type 2 diabetes mellitus remain uncertain.
Methods: We randomly assigned 1791 military veterans (mean age, 60.4 years) who had a suboptimal response to therapy for type 2 diabetes to receive either intensive or standard glucose control. Other cardiovascular risk factors were treated uniformly. The mean number of years since the diagnosis of diabetes was 11.5, and 40% of the patients had already had a cardiovascular event. The goal in the intensive-therapy group was an absolute reduction of 1.5 percentage points in the glycated hemoglobin level, as compared with the standard-therapy group. The primary outcome was the time from randomization to the first occurrence of a major cardiovascular event, a composite of myocardial infarction, stroke, death from cardiovascular causes, congestive heart failure, surgery for vascular disease, inoperable coronary disease, and amputation for ischemic gangrene.
Results: The median follow-up was 5.6 years. Median glycated hemoglobin levels were 8.4% in the standard-therapy group and 6.9% in the intensive-therapy group. The primary outcome occurred in 264 patients in the standard-therapy group and 235 patients in the intensive-therapy group (hazard ratio in the intensive-therapy group, 0.88; 95% confidence interval [CI], 0.74 to 1.05; P=0.14). There was no significant difference between the two groups in any component of the primary outcome or in the rate of death from any cause (hazard ratio, 1.07; 95% CI, 0.81 to 1.42; P=0.62). No differences between the two groups were observed for microvascular complications. The rates of adverse events, predominantly hypoglycemia, were 17.6% in the standard-therapy group and 24.1% in the intensive-therapy group.
Conclusions: Intensive glucose control in patients with poorly controlled type 2 diabetes had no significant effect on the rates of major cardiovascular events, death, or microvascular complications with the exception of progression of albuminuria (P = 0.01) [added]. (ClinicalTrials.gov number, NCT00032487.)
2009 Massachusetts Medical Society
Source: PubMed