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No Legacy Effects With Intensive Glucose Lowering in T2DM

June 10, 2019

By Reuters Staff

NEW YORK (Reuters Health) - Several years of intensive glucose lowering in type 2 diabetes does not result in a "legacy effect" that brings down the risk of major cardiovascular events (MACE), a 15-year update from the Veterans Affairs Diabetes Trial (VADT) shows.

"Furthermore, we found no evidence of a mortality benefit, no decrease in the incidence of hospitalizations over the full follow-up period, and no long-term difference in quality of life," Dr. Peter D. Reaven from the Phoenix Veterans Affairs Health Care System and colleagues reported June 5 online in The New England Journal of Medicine.

During the trial, the median glycated hemoglobin level in the intensive-therapy group was 6.9%, and the median separation of the glycated hemoglobin curves between treatment groups was 1.5 percentage points over a median of 5.6 years. The difference had fallen to 0.2%-0.3% three years after the trial ended.

A previous report from the VADT found that intensive glucose lowering reduced MACE risk by 17% during the 10 year period when the glycated hemoglobin curves remained separate.

The new study cohort included 1,655 participants (out of the original 1,791), including 1,391 who provided additional data by filling out a survey.

In this updated analysis, researchers found that in the five-year period after the glycated hemoglobin levels equalized in the two groups, risks of major cardiovascular events were no longer significantly different.

"These latter results suggest that there are modest long-term cardiovascular benefits of intensive glucose-lowering therapy in patients with more advanced diabetes," Dr. Reaven and colleagues write. "Results also show that long-term maintenance of a lower glycated hemoglobin level may be necessary to maintain these improvements."

In an editorial, Dr. Kasia J. Lipska of the Yale School of Medicine and Dr. Neda Laiteerapong of the University of Chicago write. "A major implication of the VADT follow-up study is that older patients with advanced diabetes should not expect long-term cardiovascular benefits from intensive glycemic control. Instead, interventions that clearly reduce cardiovascular risk - such as smoking cessation, blood-pressure control, statin therapy, use of antiplatelet agents, and the use of glucose-lowering agents with proven cardiovascular benefits in patients with established cardiovascular disease - should be prioritized."


N Engl J Med 2019.

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