Glucose control and vascular complications in veterans with type 2 diabetes. Export

@article{citeulike:3812969, abstract = {BACKGROUND: The effects of intensive glucose control on cardiovascular events in patients with long-standing type 2 diabetes mellitus remain uncertain. METHODS: We randomly assigned 1791 military veterans (mean age, 60.4 years) who had a suboptimal response to therapy for type 2 diabetes to receive either intensive or standard glucose control. Other cardiovascular risk factors were treated uniformly. The mean number of years since the diagnosis of diabetes was 11.5, and 40\% of the patients had already had a cardiovascular event. The goal in the intensive-therapy group was an absolute reduction of 1.5 percentage points in the glycated hemoglobin level, as compared with the standard-therapy group. The primary outcome was the time from randomization to the first occurrence of a major cardiovascular event, a composite of myocardial infarction, stroke, death from cardiovascular causes, congestive heart failure, surgery for vascular disease, inoperable coronary disease, and amputation for ischemic gangrene. RESULTS: The median follow-up was 5.6 years. Median glycated hemoglobin levels were 8.4\% in the standard-therapy group and 6.9\% in the intensive-therapy group. The primary outcome occurred in 264 patients in the standard-therapy group and 235 patients in the intensive-therapy group (hazard ratio in the intensive-therapy group, 0.88; 95\% confidence interval [CI], 0.74 to 1.05; P=0.14). There was no significant difference between the two groups in any component of the primary outcome or in the rate of death from any cause (hazard ratio, 1.07; 95\% CI, 0.81 to 1.42; P=0.62). No differences between the two groups were observed for microvascular complications. The rates of adverse events, predominantly hypoglycemia, were 17.6\% in the standard-therapy group and 24.1\% in the intensive-therapy group. CONCLUSIONS: Intensive glucose control in patients with poorly controlled type 2 diabetes had no significant effect on the rates of major cardiovascular events, death, or microvascular complications with the exception of progression of albuminuria (P = 0.01) [added]. (ClinicalTrials.gov number, NCT00032487.)}, author = {Duckworth, William and Abraira, Carlos and Moritz, Thomas and Reda, Domenic and Emanuele, Nicholas and Reaven, Peter D. and Zieve, Franklin J. and Marks, Jennifer and Davis, Stephen N. and Hayward, Rodney and Warren, Stuart R. and Goldman, Steven and McCarren, Madeline and Vitek, Mary Ellen E. and Henderson, William G. and Huang, Grant D. and {VADT Investigators}}, citeulike-article-id = {3812969}, citeulike-linkout-0 = {http://dx.doi.org/10.1056/NEJMoa0808431}, citeulike-linkout-1 = {http://content.nejm.org/cgi/content/abstract/360/2/129}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/19092145}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=19092145}, day = {8}, doi = {10.1056/NEJMoa0808431}, issn = {1533-4406}, journal = {The New England journal of medicine}, keywords = {accord, advance, interventionaltrial, mortality, vadft}, month = {January}, number = {2}, pages = {129--139}, posted-at = {2008-12-24 16:50:25}, priority = {5}, title = {Glucose control and vascular complications in veterans with type 2 diabetes.}, url = {http://dx.doi.org/10.1056/NEJMoa0808431}, volume = {360}, year = {2009} }

TY - JOUR ID - citeulike:3812969 L3 - citeulike-article-id:3812969 N2 - BACKGROUND: The effects of intensive glucose control on cardiovascular events in patients with long-standing type 2 diabetes mellitus remain uncertain. METHODS: We randomly assigned 1791 military veterans (mean age, 60.4 years) who had a suboptimal response to therapy for type 2 diabetes to receive either intensive or standard glucose control. Other cardiovascular risk factors were treated uniformly. The mean number of years since the diagnosis of diabetes was 11.5, and 40% of the patients had already had a cardiovascular event. The goal in the intensive-therapy group was an absolute reduction of 1.5 percentage points in the glycated hemoglobin level, as compared with the standard-therapy group. The primary outcome was the time from randomization to the first occurrence of a major cardiovascular event, a composite of myocardial infarction, stroke, death from cardiovascular causes, congestive heart failure, surgery for vascular disease, inoperable coronary disease, and amputation for ischemic gangrene. RESULTS: The median follow-up was 5.6 years. Median glycated hemoglobin levels were 8.4% in the standard-therapy group and 6.9% in the intensive-therapy group. The primary outcome occurred in 264 patients in the standard-therapy group and 235 patients in the intensive-therapy group (hazard ratio in the intensive-therapy group, 0.88; 95% confidence interval [CI], 0.74 to 1.05; P=0.14). There was no significant difference between the two groups in any component of the primary outcome or in the rate of death from any cause (hazard ratio, 1.07; 95% CI, 0.81 to 1.42; P=0.62). No differences between the two groups were observed for microvascular complications. The rates of adverse events, predominantly hypoglycemia, were 17.6% in the standard-therapy group and 24.1% in the intensive-therapy group. CONCLUSIONS: Intensive glucose control in patients with poorly controlled type 2 diabetes had no significant effect on the rates of major cardiovascular events, death, or microvascular complications with the exception of progression of albuminuria (P = 0.01) [added]. (ClinicalTrials.gov number, NCT00032487.) IS - 2 JF - The New England journal of medicine SN - 1533-4406 EP - 139 TI - Glucose control and vascular complications in veterans with type 2 diabetes. VL - 360 SP - 129 KW - accord KW - advance KW - interventionaltrial KW - mortality KW - vadft AU - Duckworth, William AU - Abraira, Carlos AU - Moritz, Thomas AU - Reda, Domenic AU - Emanuele, Nicholas AU - Reaven, Peter AU - Zieve, Franklin AU - Marks, Jennifer AU - Davis, Stephen AU - Hayward, Rodney AU - Warren, Stuart AU - Goldman, Steven AU - McCarren, Madeline AU - Vitek, Mary Ellen AU - Henderson, William AU - Huang, Grant PY - 2009/01/08/ UR - http://dx.doi.org/10.1056/NEJMoa0808431 ER -