Diabetes: Control - Slide 21

Recent Clinical Trial Findings:

• Intensive glucose control in type 2 diabetes:

  • lowers risk of new or worsening microvascular complications (ADVANCE)

  • was associated with increased mortality in patients with longstanding DM and known CVD (ACCORD)

  • increases risk of severe hypoglycemia (ADVANCE, ACCORD and VADT)

ACCORD: N Engl J Med 2008; 358(24):2545-59
ADVANCE: N Engl J Med 2008; 358 (24): 2560-72
VADT: J Diabetes Complications 2003; 17 (6): 314-22

Note:

• A proven benefit of intensive glucose control:

  1. Lowers risk of new or worsening microvascular complications (damage to small vessels that cause kidney and eye damage) (ADVANCE).

• However, results of three major clinical trials (ADVANCE, ACCORD and VA Diabetes Trial) confirmed that intensive glucose control in type 2 diabetes presents significant risks. These are:

  1. Intensive glucose control was associated with increased mortality in patients with longstanding DM and known CVD (ACCORD).

  2. Intensive control increases risk of severe hypoglycemia (ADVANCE, ACCORD and VADT).

Reference

Action to Control Cardiovascular Risk in Diabetes (ACCORD) N Engl J Med 2008; 358(24):2545-59

Action in Diabetes and Vascular Disease: PreterAx and DiamicroN MR Controlled Evaluation (ADVANCE) N Engl J Med 2008; 358 (24): 2560-72

Veterans Affairs Diabetes Trial (VDAT): J Diabetes Complications 2003; 17 (6): 314-22

Revised November 2008