The association between metabolic control and prevalent macrovascular disease in Type 2 diabetes: the VA Cooperative Study in diabetes.
OBJECTIVE
Macrovascular disease (MVD), especially coronary heart disease, is the most common cause of mortality in Type 2 diabetes. We assessed the association between demographic and clinical variables (particularly HbA1c) and prevalent MVD at time of enrollment into the VA Diabetes Trial (VADT), a 7-year randomized trial to determine whether intensive glycemic control will reduce risk of MVD events in older participants with established Type 2 diabetes.


METHODS
We compared the demographic, treatment, and clinical characteristics of participants with and without known MVD, then assessed the interaction of multiple variables with HbA1c. Logistic regression models evaluated the association between HbA1c quartiles and prevalence of MVD, adjusting for potentially confounding variables.


RESULTS
Several variables were associated with prevalent MVD (age, duration of diabetes, insulin use but not daily dosage, smoking history, hypertension, BMI, Caucasian race, non-Hispanic ethnicity, lower HDL cholesterol, higher triglycerides, lower LDL cholesterol, and statin use). In univariate analysis, there was no association of HbA1c with MVD (mean: 9.4+/-1.46% in those with MVD, 9.5+/-1.58% in those without). Multivariate analyses found little confounding of the lack of association of HbA1c with MVD. Only adjustment for age produced a slight increase in the odds ratio, but only for the highest quartile of HbA1c.


CONCLUSIONS
In this cross-sectional analysis, MVD was associated with a number of clinical and demographic variables but not with HbA1c. Determining whether intensive lowering of HbA1c will reduce the prospective rate of MVD events in this population of older participants with established Type 2 diabetes is the primary objective of our trial.
Kirkman
M Sue
MS
The Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA. mkirkman@iupui.edu
McCarren
Madeline
M
Shah
Jayendra
J
Duckworth
William
W
Abraira
Carlos
C
D001786:Blood Glucose; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D008055:Lipids / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids