TY - JOUR
T1 - Does aggressive glycemic control benefit macrovascular and microvascular disease in type 2 diabetes?
T2 - Insights from ACCORD, ADVANCE, and VADT
AU - Terry, Toni
AU - Raravikar, Kalyani
AU - Chokrungvaranon, Nalurporn
AU - Reaven, Peter D.
N1 - Funding Information:
Disclaimer This material is based upon work supported in part by the Department of Veterans Affairs Cooperative Studies Program. The contents do not represent the views of the Department of Veterans Affairs or the United States Government.
Funding Information:
Disclosure Conflicts of interest: T. Terry: none; K. Raravikar: none; N. Chokrungvaranon: none; P. Reaven: has received grant support from Amylin and Takada.
PY - 2012/2
Y1 - 2012/2
N2 - Diabetes is increasing rapidly worldwide and frequently results in severe vascular complications. A target glycated hemoglobin of less than 7% has commonly been recommended in hopes of preventing both macrovascular and microvascular complications. Although results from trials of intensive glycemic control have generally supported the notion that lower glycated hemoglobin values reduce microvascular disease, the evidence for similar benefits for macrovascular disease has been less clear. As macrovascular disease is the major cause of morbidity and mortality in type 2 diabetes, this remains one of the more important unresolved clinical questions. Recent results from the ACCORD, ADVANCE, and VADT studies have challenged the conventional believe that lower glycated hemoglobin values should be pursued in all diabetic patients. Factors that may influence whether intensive glucose management is advisable include duration of diabetes, pre-existing macrovascular disease, hypoglycemic unawareness, and significant comorbidities. Glycated hemoglobin goals should account for these factors and be individualized for each patient.
AB - Diabetes is increasing rapidly worldwide and frequently results in severe vascular complications. A target glycated hemoglobin of less than 7% has commonly been recommended in hopes of preventing both macrovascular and microvascular complications. Although results from trials of intensive glycemic control have generally supported the notion that lower glycated hemoglobin values reduce microvascular disease, the evidence for similar benefits for macrovascular disease has been less clear. As macrovascular disease is the major cause of morbidity and mortality in type 2 diabetes, this remains one of the more important unresolved clinical questions. Recent results from the ACCORD, ADVANCE, and VADT studies have challenged the conventional believe that lower glycated hemoglobin values should be pursued in all diabetic patients. Factors that may influence whether intensive glucose management is advisable include duration of diabetes, pre-existing macrovascular disease, hypoglycemic unawareness, and significant comorbidities. Glycated hemoglobin goals should account for these factors and be individualized for each patient.
KW - ACCORD
KW - ADVANCE
KW - Advanced glycation end products
KW - Atherosclerosis
KW - Coronary artery calcium
KW - Diabetes duration
KW - Glycated hemoglobin
KW - Hypoglycemic unawareness
KW - Intensive glycemic control
KW - Macrovascular disease
KW - Metabolic memory
KW - Microvascular disease
KW - Type 2 diabetes
KW - UGDP
KW - UKPDS
KW - VADT
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U2 - 10.1007/s11886-011-0238-6
DO - 10.1007/s11886-011-0238-6
M3 - Article
C2 - 22160862
AN - SCOPUS:84857631399
SN - 1523-3782
VL - 14
SP - 79
EP - 88
JO - Current Cardiology Reports
JF - Current Cardiology Reports
IS - 1
ER -