title: Diabetes and cardiovascular disease: the role of glycemic control.
abstract: Over the past decade, clinical practice guidelines have lowered their glycemic targets for people with type 2 diabetes. However, recent randomized controlled trials (ACCORD, ADVANCE, and VADT) demonstrate that intensive glycemic targets do not reduce cardiovascular risk among higher-risk individuals over a period of 3.5 to 5 years. Thus, targeting a hemoglobin A(1c) below 6% among high-risk patients should not be recommended. However, the 10-year post-trial monitoring of the UKPDS demonstrated cardiovascular benefit of intensive glycemic control among those with newly diagnosed type 2 diabetes over a median follow-up of 17 years. This raises the possibility that cardiovascular benefits of glycemic control require many years to manifest and early intervention may carry greater benefit. Therefore, these recent trials continue to support the recommended hemoglobin A(1c) target of below 7% to reduce microvascular complications in type 2 diabetes and perhaps macrovascular complications in those with newly diagnosed diabetes.
authors.affiliation: St. Michael's Hospital, 6121-61 Queen Street East, Toronto, Ontario M5C 2T2, Canada.
authors.forename: Alice Y Y
authors.initials: AY
authors.lastname: Cheng
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D048909:Diabetes Complications / Q000378:metabolism* / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000517:prevention & control*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin