Effects of intensive glucose lowering in type 2 diabetes.

@article{Gerstein2008EffectsOI,
  title={Effects of intensive glucose lowering in type 2 diabetes.},
  author={Hertzel C. Gerstein and Michael E. Miller and Robert P. Byington and David C. Goff and J. Thomas Bigger and John B. Buse and William C. Cushman and Saul M. Genuth and Faramarz Ismail-Beigi and Richard H. Grimm and Jeffrey L. Probstfield and Denise G. Simons-Morton and William T. Friedewald},
  journal={The New England journal of medicine},
  year={2008},
  volume={358 24},
  pages={
          2545-59
        }
}
BACKGROUND Epidemiologic studies have shown a relationship between glycated hemoglobin levels and cardiovascular events in patients with type 2 diabetes. We investigated whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who had either established cardiovascular disease or additional cardiovascular risk factors. METHODS In this randomized study, 10,251 patients (mean age, 62.2 years) with a median glycated… Expand

Paper Mentions

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ConditionsDiabetes Mellitus Type 2
InterventionDrug
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InterventionDrug, Other
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Conventional lifestyle modification in the management of type 2 diabetes focuses on weight loss, through caloric restriction and exercise, to reduce insulin resistance. This approach… Expand
ConditionsDiabetes Mellitus, Type 2
InterventionBehavioral
Effects of Intensive Glucose Lowering in Type 2 Diabetes
TLDR
The use of intensive therapy to target normal glycated hemoglobin levels for 3.5 years increased mortality and did not significantly reduce major cardiovascular events, identifying a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes. Expand
Long-term effects of intensive glucose lowering on cardiovascular outcomes.
TLDR
The use of intensive therapy for 3.7 years to target a glycated hemoglobin level below 6% reduced 5-year nonfatal myocardial infarctions but increased 5- year mortality, and such a strategy cannot be recommended for high-risk patients with advanced type 2 diabetes. Expand
Glucose control and vascular complications in veterans with type 2 diabetes.
TLDR
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. Expand
Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.
TLDR
A strategy of intensive glucose control, involving gliclazide (modified release) and other drugs as required, that lowered the glycated hemoglobin value to 6.5% yielded a 10% relative reduction in the combined outcome of major macrovascular and microvascular events, primarily as a consequence of a 21%relative reduction in nephropathy. Expand
Antidiabetic agents and cardiovascular risk in type 2 diabetes
  • S. Zarich
  • Medicine
  • Nature Reviews Endocrinology
  • 2009
TLDR
A comprehensive and multifactorial intervention strategy that includes aggressive glycemic control, blood-pressure- Lowering and lipid-lowering therapy, aspirin use and lifestyle modifications is beneficial in reducing both macrovascular and microvascular events in patients with T2DM. Expand
Is glucose normalization an evidence-based treatment for patients with type 2 diabetes mellitus?
TLDR
A randomized, controlled trial that assessed the effect of an intensive therapy targeting a normal HbA1c level as compared with standard therapy in patients with T2DM at high risk of cardiovascular events found that major cardiovascular events occurred in fewer patients in the intensive therapy group, but the total mortality was higher, which lead to the premature termination of the study after 3.5 years. Expand
Effects of intensive blood-pressure control in type 2 diabetes mellitus.
TLDR
In patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm HG, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events. Expand
Intensive glucose control improves kidney outcomes in patients with type 2 diabetes.
TLDR
Improved glucose control will improve major kidney outcomes in patients with type 2 diabetes, and the progression of albuminuria was significantly reduced and its regression significantly increased. Expand
Effects of medical therapies on retinopathy progression in type 2 diabetes.
TLDR
Intensive glycemic control and intensive combination treatment of dyslipidemia, but not intensive blood-pressure control, reduced the rate of progression of diabetic retinopathy. Expand
Cardiovascular disease and intensive glucose control in type 2 diabetes mellitus: moving practice toward evidence-based strategies
TLDR
The results of 4 recently published randomized controlled trials did not demonstrate a significant reduction of cardiovascular events in the intensive group compared to the standard group, which contrasts strongly with the long-term postintervention outcomes of UKPDS, which show a persistent benefit of glycemic control during 10 years of post-trial follow-up. Expand
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References

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Effects of Intensive Glucose Lowering in Type 2 Diabetes
TLDR
The use of intensive therapy to target normal glycated hemoglobin levels for 3.5 years increased mortality and did not significantly reduce major cardiovascular events, identifying a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes. Expand
Glycemia treatment strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
TLDR
The hypothesis that aggressive glucose lowering prevents CVD events in patients with type 2 diabetes is addressed and information on how to safely approach near-normal levels of glucose control in clinical practice and evidence to support future clinical guidelines for diabetes management in older adults is provided. Expand
Meta-Analysis: Glycosylated Hemoglobin and Cardiovascular Disease in Diabetes Mellitus
TLDR
A systematic review of prospective cohort studies of glycosylated hemoglobin and cardiovascular disease in persons with diabetes mellitus found a graded relationship between fasting and postprandial blood glucose levels and subsequent risk for a cardiovascular event. Expand
Hyperglycemia and its effect after acute myocardial infarction on cardiovascular outcomes in patients with Type 2 diabetes mellitus (HEART2D) Study design.
TLDR
The HEART2D study seeks to determine the effect that PPBG control has on cardiovascular outcomes in patients who suffered an MI within the 21 days before study enrollment and may provide practical insights into the clinical management of patients with diabetes. Expand
Cardiovascular events and correlates in the Veterans Affairs Diabetes Feasibility Trial. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes.
TLDR
A long-term prospective trial is needed to assess the risk-benefit ratio of intensive insulin therapy for NIDDM in patients who require it. Expand
Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods.
TLDR
The ACCORD trial should document for the first time the benefits and risks of intensive glucose control, intensive blood pressure control, and the combination of fibrate and statin drugs in managing blood lipids in high-risk patients with type 2 diabetes. Expand
The relationship between dysglycaemia and cardiovascular and renal risk in diabetic and non-diabetic participants in the HOPE study: a prospective epidemiological analysis
TLDR
There is an independent progressive relationship between indices of glycaemia and incident CV events, renal disease and death and clinical trials of glucose lowering to prevent these outcomes in diabetic and non-diabetic individuals are indicated. Expand
Prevention of cardiovascular disease in persons with type 2 diabetes mellitus: current knowledge and rationale for the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
TLDR
The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial will test hypotheses to address unanswered questions regarding prevention of CVD in patients with diabetes, including the benefits of near-normal glycemic control, comprehensive therapy for diabetes-related dyslipidemia, and optimal blood pressure control. Expand
Evolution of the lipid trial protocol of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
TLDR
The current protocol is designed to provide an ethically justifiable test of combined statin plus fibrate treatment consistent with the highest level of safety and lipid treatment standards of care. Expand
Rationale, design, and baseline characteristics for a large international trial of cardiovascular disease prevention in people with dysglycemia: the ORIGIN Trial (Outcome Reduction with an Initial Glargine Intervention).
TLDR
The ORIGIN trial will determine whether or not either or both of the insulin and omega-3 fatty acid interventions can reduce CV events. Expand
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