title: Glucose control and outcome in patients with stable diabetes and previous coronary, cerebrovascular or peripheral artery disease. Findings from the FRENA Registry.
abstract: OBJECTIVE
  The aim of this study was to address the controversy over the influence of intensive glucose control on the risk for cardiovascular events in patients with Type 2 diabetes.
  
  
  METHODS
  FRENA is an ongoing registry of stable outpatients with symptomatic coronary artery disease, cerebrovascular disease or peripheral artery disease. We compared the incidence of subsequent ischaemic events (myocardial infarction, stroke or critical limb ischaemia) in patients with Type 2 diabetes and mean HbA(1c) levels < 7.0% (< 53 mmol/mol) vs. those with HbA(1c) levels > 7.0% (> 53 mmol/mol).
  
  
  RESULTS
  Of 974 patients with Type 2 diabetes, 480 (49%) had mean HbA(1c) levels < 7% (< 53 mmol/mol). Over a mean follow-up of 14 months, 126 patients (13%) had subsequent ischaemic events: myocardial infarction (43), stroke (29) and critical limb ischaemia (64). The incidence of subsequent ischaemic events was significantly lower in patients with mean HbA(1c) levels < 7.0% (< 53 mmol/mol) than in those with HbA(1c) levels > 7.0% (> 53 mmol/mol) (8.6 vs. 14 per 100 patient-years; rate ratio 0.6; 95% CI 0.4-0.9). These differences persisted after adjusting for potential confounders. However, this better outcome was only found in patients presenting with coronary artery disease (rate ratio 0.4; 95% CI 0.2-0.8), not in those with cerebrovascular disease (rate ratio 0.9; 95% CI 0.4-2.0) or peripheral artery disease (rate ratio 0.8; 95% CI 0.5-1.3). Patients with mean HbA(1c) levels < 7.0% (< 53 mmol/mol) also had a lower mortality (rate ratio 0.6; 95% CI 0.3-0.99).
  
  
  CONCLUSIONS
  In secondary prevention, patients with diabetes and HbA(1c) levels < 7.0% (< 53 mmol/mol) had a lower incidence of subsequent ischaemic events and a lower mortality than those with HbA(1c) levels > 7.0% (> 53 mmol/mol). These differences appeared only in patients with coronary artery disease.
authors.affiliation: Department of Internal Medicine, Health Research Institute, Pere Virgili, Hospital Comarcal Mora d'Ebre, Tarragona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Camafort
authors.forename: L R
authors.initials: LR
authors.lastname: Alvarez-Rodríguez
authors.forename: J F S
authors.initials: JF
authors.lastname: Muñoz-Torrero
authors.forename: J C
authors.initials: JC
authors.lastname: Sahuquillo
authors.forename: L
authors.initials: L
authors.lastname: López-Jiménez
authors.forename: R
authors.initials: R
authors.lastname: Coll
authors.forename: M
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002561:Cerebrovascular Disorders / Q000139:chemically induced / Q000401:mortality / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000139:chemically induced / Q000401:mortality / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D016491:Peripheral Vascular Diseases / Q000139:chemically induced / Q000401:mortality / Q000503:physiopathology*; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin