title: The effect of intensive glucose lowering therapy among major racial/ethnic groups in the Veterans Affairs Diabetes Trial.
abstract: OBJECTIVE
  To examine the effect of intensive glycemic control on cardiovascular disease events (CVD) among the major race/ethnic groups in a post-hoc analysis of the VADT.
  
  
  METHODS
  Participants included 1111 non-Hispanic Whites, 307 Hispanics and 306 non-Hispanic Blacks randomized to intensive or standard glucose treatment in VADT. Multivariable Cox proportional hazards models were constructed to assess the effect of intensive glucose treatment on CVD events among race/ethnic groups.
  
  
  RESULTS
  Mean age was 60.4 years and median follow-up was 5.6 years. By design, modifiable risk factors were managed equally well in both treatment arms and only differed modestly between race/ethnic groups. HbA(1c) decreased significantly from baseline with intensive glucose treatment in each race/ethnic group, with a trend for a greater response in Hispanics (P=0.02 for overall comparison between groups). Intensive glucose treatment was associated with reduced risk of CVD events for Hispanics but not for others (hazard ratios ranged from 0.54 to 0.75 for Hispanics whereas they were consistently close to 1 for others). Sensitivity analyses with different definitions of race/ethnicity or limited to individuals free of previous known CVD yielded similar results.
  
  
  CONCLUSIONS
  The results of these analyses support the hypothesis that race/ethnicity is worthy of consideration when tailoring intensive treatment for individuals with long-standing type 2 diabetes. However, additional studies are needed to confirm the findings of this post-hoc analysis.
authors.affiliation: Phoenix VA Health Care System, Phoenix, Arizona. Electronic address: Aramesh.Saremi@va.gov.
authors.forename: Aramesh
authors.initials: A
authors.lastname: Saremi
authors.affiliation: Phoenix VA Health Care System, Phoenix, Arizona.
authors.forename: Dawn C
authors.initials: DC
authors.lastname: Schwenke
authors.affiliation: Cooperative Studies Program Coordinating Center, Hines, Illinois.
authors.forename: Gideon
authors.initials: G
authors.lastname: Bahn
authors.affiliation: Cooperative Studies Program Coordinating Center, Hines, Illinois.
authors.forename: Ling
authors.initials: L
authors.lastname: Ge
authors.affiliation: Medical and Research Services, Hines Veterans Affairs Hospital, Hines, Illinois.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Emanuele
authors.affiliation: Phoenix VA Health Care System, Phoenix, Arizona. Electronic address: Peter.Reaven@Va.gov.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Reaven
mesh_terms: D001741:Black or African American; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000150:complications / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D058065:Diabetic Cardiomyopathies / Q000150:complications / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006630:Hispanic or Latino; D006787:Hospitals, Veterans; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D057285:Precision Medicine; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: CVD; Ethnicity; Intensive glycemic control; Race; Type 2 diabetes