Does aggressive glycemic control benefit macrovascular and microvascular disease in type 2 diabetes? Insights from ACCORD, ADVANCE, and VADT

Toni Terry, Kalyani Raravikar, Nalurporn Chokrungvaranon, Peter D. Reaven

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)79-88
Number of pages10
JournalCurrent Cardiology Reports
Volume14
Issue number1
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

Keywords

  • ACCORD
  • ADVANCE
  • Advanced glycation end products
  • Atherosclerosis
  • Coronary artery calcium
  • Diabetes duration
  • Glycated hemoglobin
  • Hypoglycemic unawareness
  • Intensive glycemic control
  • Macrovascular disease
  • Metabolic memory
  • Microvascular disease
  • Type 2 diabetes
  • UGDP
  • UKPDS
  • VADT

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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