Recent data analysis by researchers at the University of Cambridge suggests that tight blood glucose control in people with Type 2 diabetes can reduce the risk of cardiovascular events by as much as 17%, addressing some of the controversy raised by previous research such as the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, the Action in Diabetes and Vascular Disease (ADVANCE) study, and the Veterans Affairs Diabetes Trial (VADT).
One of the purposes of these trials had been to determine the effect of intensive blood glucose control on the risk of cardiovascular events in people with Type 2 diabetes. The blood-glucose-lowering arm of the ACCORD study was stopped early due to an increased death rate in people intensively controlling their blood glucose. Neither ADVANCE nor VADT showed a significant effect of blood glucose control on the rates of cardiovascular events.
Using a method of research known as meta-analysis, in which the statistics from several studies are combined and examined, the Cambridge investigators looked at the results of the ACCORD, ADVANCE, and VADT studies, in addition to the results from the United Kingdom Prospective Diabetes Study (UKPDS, first reported on in 1998) and the Prospective Pioglitazone Clinical Trial in Macrovascular Events (PROACTIVE, first reported on in 2004). Among the 33,040 people involved in these trials, those using intensive blood glucose management had an average HbA1c level (a measure of blood glucose control over the previous 2–3 months) 0.9% lower than those using standard blood glucose therapy. During the follow-up period of roughly 163,000 person-years, the data showed a 17% reduction in heart attacks and a 15% reduction in coronary heart disease events among those following the intensive regimen. The research did not show a link between intensive control and the risk of stroke or all-cause mortality rates.
Lead investigator Kausik Ray, MD, cautions that further research is needed to determine specifically who should be advised against pursuing intensive blood glucose control. However, according to an article on WebMD’s Heartwire, the meta-analysis “should help clinicians feel more comfortable adhering to the clinical guideline target of HbA1c.”
For more information, see “Intensive glucose control reduces MI and CHD-event risk, new meta-analysis shows,” by Michael O’Riordan.
Dear diane.
I have been a believer in intensive therapy since developping diabetes. Now with a prodigious amout of insulin 0.7 units per Kg of body weight per day and a low carb diet I can keep the HA1c in the 6% to 6.5% range. But at the cost of a continuing weight gain of about 5 lb per year. And there is nothing that I can do to counter act that so far. And I consider myself about 10 lb to go before death.
There are other downsides to tight control. It is more stressful. Injecting insulin is not an exact science it is like Russian roulette and you never know when you can go low a stressful experience at least and for some people possibly dangerous. The low carb diet necessary for this level of control is also stressful I do not eat much rice, patato or bread. Anyways veggies and fruit compensate.
On the other hand I do not have any complications.
I would recommend thight control to anyone one that can do it without any weight gain and that can cope with the stress.
Posted by CalgaryDiabetic | Jun 08, 2009 at 12:38 pmQuality of life should be weighed against the stress of strict glucose control. There are no contracts with God or fate. We can strictly control glucose only to die young from another disease. Then what did you have? No enjoyment from eating plus your only life is gone. Moderation in everything is best. I find good quality fish oil solves my heart problems and I try to keep away from high glycemic foods, ‘most of the time’!
Posted by Henry Ford | Jun 10, 2009 at 8:36 pmI would imagine there’s absolutely a vital link between these two issues (I’m a newbie but I’ve been researching heart surgery online lately). I’ve read over and over that an active lifestyle leads to long life and of course proper maintenance of blood sugar levels for diabetics is a part of that. Activity is encouraged for diabetics, right? Sorry if I’m wrong on that, still learning all this stuff.
Posted by SinceSpidey | Jun 18, 2009 at 9:39 pm