Intensive Diabetes Management Offers No Long-Term Benefit for Reducing CV Risk

US military veterans who received intensive glucose control therapy for type 2 diabetes over a median 5.6 years had no lower risk of cardiovascular events over 15 years than those who received standard glucose therapy, according to a study published in The New England Journal of Medicine.

The study was a follow-up from the Veterans Affairs Diabetes Trial, in which half of 1791 participants were randomized to receive intensive therapy that consisted of slightly elevated doses of thiazolidinediones, insulin, oral sulfonylureas, and acarbose. The other half of the study population received standard therapy doses.

As with the initial trial, the recent 15-year follow-up findings demonstrated no significant drop in cardiovascular events with intensive glucose control compared with standard control, according to the article. Some 1665 participants from the original cohort were included in the follow-up study.

“Over a period of 15 years of follow-up (active treatment plus post-trial observation), the risks of major cardiovascular events or death were not lower in the intensive-therapy group than in the standard-therapy group,” researchers wrote in The New England Journal of Medicine. “The risk of major cardiovascular disease outcomes was reduced, however, during an extended interval of separation of the glycated hemoglobin curves, but this benefit did not continue after equalization of the glycated hemoglobin levels.”

The study found no difference in the risk of death from cardiovascular cause nor any cause between the two groups, according to the study. Furthermore, health-related quality of life was not significantly better with intensive therapy compared with standard therapy.

—Jolynn Tumolo

Reference

Reaven PD, Emanuele NV, Wiitala WL, et al. Intensive glucose control in patients with type 2 diabetes - 15-year follow-up. N Eng J Med. 2019;380(23):2215-2224.