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.