Glucose control and vascular complications in veterans with type 2 diabetes - PubMed (original) (raw)
Randomized Controlled Trial
. 2009 Jan 8;360(2):129-39.
doi: 10.1056/NEJMoa0808431. Epub 2008 Dec 17.
Carlos Abraira, Thomas Moritz, Domenic Reda, Nicholas Emanuele, Peter D Reaven, Franklin J Zieve, Jennifer Marks, Stephen N Davis, Rodney Hayward, Stuart R Warren, Steven Goldman, Madeline McCarren, Mary Ellen Vitek, William G Henderson, Grant D Huang; VADT Investigators
Collaborators, Affiliations
- PMID: 19092145
- DOI: 10.1056/NEJMoa0808431
Free article
Randomized Controlled Trial
Glucose control and vascular complications in veterans with type 2 diabetes
William Duckworth et al. N Engl J Med. 2009.
Free article
Erratum in
- N Engl J Med. 2009 Sep 3;361(10):1028
- Veterans Affairs diabetes trial--corrections.
Moritz T, Duckworth W, Abraira C. Moritz T, et al. N Engl J Med. 2009 Sep 3;361(10):1024-5. doi: 10.1056/NEJMc096250. N Engl J Med. 2009. PMID: 19726779 No abstract available.
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.)
2009 Massachusetts Medical Society
Comment in
- ACP Journal Club. Intensive and standard glucose control did not differ for major CV events or death in poorly controlled type 2 diabetes.
Booth GL. Booth GL. Ann Intern Med. 2009 Mar 17;150(6):JC3-8. doi: 10.7326/0003-4819-150-6-200903170-02008. Ann Intern Med. 2009. PMID: 19306490 No abstract available. - Glucose control and vascular complications in type 2 diabetes.
Banarer S. Banarer S. N Engl J Med. 2009 May 7;360(19):2031; author reply 2032. doi: 10.1056/NEJMc090262. N Engl J Med. 2009. PMID: 19420376 No abstract available. - Glucose control and vascular complications in type 2 diabetes.
Luan FL. Luan FL. N Engl J Med. 2009 May 7;360(19):2031-2; author reply 2032. N Engl J Med. 2009. PMID: 19425194 No abstract available. - Intensive and standard glucose control did not differ for CV events or death in poorly controlled type 2 diabetes.
Booth GL. Booth GL. Evid Based Med. 2009 Jun;14(3):73. doi: 10.1136/ebm.14.3.73. Evid Based Med. 2009. PMID: 19483022 No abstract available. - Veterans Affairs diabetes trial--corrections.
Moritz T, Duckworth W, Abraira C. Moritz T, et al. N Engl J Med. 2009 Sep 3;361(10):1024-5. doi: 10.1056/NEJMc096250. N Engl J Med. 2009. PMID: 19726779 No abstract available. - [Intensive blood glucose control in type 2 diabetic patients does not have a significant effect on macrovascular complications].
Steurer J. Steurer J. Praxis (Bern 1994). 2009 Oct 7;98(20):1171-2. doi: 10.1024/1661-8157.98.20.1171. Praxis (Bern 1994). 2009. PMID: 19809983 German. No abstract available.
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