title: [Intensive glucose control in type 2 diabetes: is it harmful, needless or maybe useful in reducing cardiovascular risk?].
abstract: Type 2 diabetes represents a major cardiovascular risk. The main feature of diabetes is hyperglycemia and several molecular mechanisms might indeed explain how hyperglycemia can result in vascular damage. If hyperglycemia represents a noxa for the vessel wall, then reducing hyperglycemia and treating diabetic patients to normoglycemia should result in a significant reduction in cardiovascular risk. However, three recent, ample clinical trials designed to demonstrate the effectiveness of tight glucose control in reducing macrovascular complications fell short from offering such an evidence and actually hinted that tight glucose control might be harmful. The present review offers a critical interpretation of the results of such trials by discussing how patients selection, length of follow-up, prevalence of hypoglycemia and pharmacological strategies used might have prevented from demonstrating a positive effect of blood glucose control on vascular events. It is concluded that trials conducted in younger cohorts, free from a bad metabolic legacy due to long standing poor glucose control are needed to establish the real role of intensive glucose control on morbidity and mortality. Such trials should entail the use of the newer anti-diabetes agents which are not exposing the patients to the risk of hypoglycemia and weight gain.
authors.affiliation: Dipartimento di Medicina Interna e Scienze dell'Invecchiamento, Università degli Studi "G. D'Annunzio", Chieti. consoli@unich.it
authors.forename: Agostino
authors.initials: A
authors.lastname: Consoli
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors