Should patients with type 2 diabetes focus on glycemic control to reduce their cardiovascular risk?
3 very large randomized trials have recently announced their results, massively expanding the evidence base for the efficacy and safety of intensive glycemic control in patients with type 2 diabetes. Taken together, these trials indicate that tight glycemic control is potentially harmful (one of the trials was stopped earlier than planned because of an increased risk of death in patients assigned to the intensive glycemic control arm) while offering potential benefits of unclear importance to patients. In this commentary, we review these trials, their methods, results, and implications for practice. We finish by formulating a recommended approach to the contemporary evidence-based management of patients with type 2 diabetes.
Division of Endocrinology, Metabolism, Diabetes, Nutrition, and Internal Medicine, Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, MN 55905, USA. montori.victor@mayo.edu
Victor M
VM
Montori
D000959:Antihypertensive Agents / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000139:chemically induced / Q000517:prevention & control*; D003928:Diabetic Nephropathies / Q000139:chemically induced / Q000517:prevention & control; D004359:Drug Therapy, Combination; D038321:Glycemic Index / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic
D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents