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Does Aggressive Glycemic Control Benefit Macrovascular and Microvascular Disease in Type 2 Diabetes?: Insights from ACCORD, ADVANCE, and VADT

  • Diabetes and Cardiovascular Disease (ND Wong, Section Editor)
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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.

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Abbreviations

ACCORD:

Action to Control Cardiovascular Risk in Diabetes

ADVANCE:

Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation

DCCT:

Diabetes Control and Complications Trial

UGDP:

University Group Diabetes Program

UKPDS:

United Kingdom Prospective Diabetes Study

VADT:

Veterans Affairs Diabetes Trial

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Disclosure

Conflicts of interest: T. Terry: none; K. Raravikar: none; N. Chokrungvaranon: none; P. Reaven: has received grant support from Amylin and Takada.

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.

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Authors and Affiliations

  1. Division of Endocrinology, Phoenix VA Health Care System, 650 East Indian School Road, Phoenix, AZ, 85012, USA

    Toni Terry & Peter D. Reaven

  2. Research Department, Endocrine Section, Phoenix VA Health Care System, 650 East Indian School Road, Phoenix, AZ, 85012, USA

    Kalyani Raravikar

  3. Endocrinology, University of Missouri Kansas City, 2301 Holmes Street, Kansas City, MO, 64108, USA

    Nalurporn Chokrungvaranon

  4. Arizona State University, Tempe, AZ, USA

    Peter D. Reaven

  5. University of Arizona, Phoenix, AZ, USA

    Peter D. Reaven

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  1. Toni Terry
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  4. Peter D. Reaven
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Correspondence to Toni Terry.

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Terry, T., Raravikar, K., Chokrungvaranon, N. et al. Does Aggressive Glycemic Control Benefit Macrovascular and Microvascular Disease in Type 2 Diabetes?: Insights from ACCORD, ADVANCE, and VADT. Curr Cardiol Rep 14, 79–88 (2012). https://doi.org/10.1007/s11886-011-0238-6

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  • DOI: https://doi.org/10.1007/s11886-011-0238-6

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