Glucose control and vascular complications in veterans with type 2 diabetes

William Duckworth, Carlos Abraira, Thomas Moritz, Domenic Reda, Nicholas Emanuele, Peter D. Reaven, Franklin J. Zieve, Jennifer B Marks, Stephen N. Davis, Rodney Hayward, Stuart R. Warren, Steven Goldman, Madeline McCarren, Mary Ellen Vitek, William G. Henderson, Grant D. Huang

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The effects of intensive glucose control on cardiovascular events in patients with longstanding type 2 diabetes mellitus remain uncertain. METHODS: We randomly assigned 1791 military veterans (mean age, 60.4 years) who had a suboptimal response to therapy for type 2 diabetes to receive either intensive or standard glucose control. Other cardiovascular risk factors were treated uniformly. The mean number of years since the diagnosis of diabetes was 11.5, and 40% of the patients had already had a cardiovascular event. The goal in the intensive-therapy group was an absolute reduction of 1.5 percentage points in the glycated hemoglobin level, as compared with the standard-therapy group. The primary outcome was the time from randomization to the first occurrence of a major cardiovascular event, a composite of myocardial infarction, stroke, death from cardiovascular causes, congestive heart failure, surgery for vascular disease, inoperable coronary disease, and amputation for ischemic gangrene. RESULTS: The median follow-up was 5.6 years. Median glycated hemoglobin levels were 8.4% in the standard-therapy group and 6.9% in the intensive-therapy group. The primary outcome occurred in 264 patients in the standard-therapy group and 235 patients in the intensive-therapy group (hazard ratio in the intensive-therapy group, 0.88; 95% confidence interval [CI], 0.74 to 1.05; P = 0.14). There was no significant difference between the two groups in any component of the primary outcome or in the rate of death from any cause (hazard ratio, 1.07; 95% CI, 0.81 to 1.42; P = 0.62). No differences between the two groups were observed for microvascular complications. The rates of adverse events, predominantly hypoglycemia, were 17.6% in the standard-therapy group and 24.1% in the intensive-therapy group. CONCLUSIONS: 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. (ClinicalTrials.gov number, NCT00032487.)

Original languageEnglish
Pages (from-to)129-139
Number of pages11
JournalNew England Journal of Medicine
Volume360
Issue number2
DOIs
StatePublished - Jan 8 2009

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Veterans
Group Psychotherapy
Type 2 Diabetes Mellitus
Blood Vessels
Glucose
Glycosylated Hemoglobin A
Cause of Death
Myocardial Infarction
Confidence Intervals
Gangrene
Random Allocation
Vascular Diseases
Amputation
Hypoglycemia
Thoracic Surgery
Coronary Disease
Heart Failure
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Duckworth, W., Abraira, C., Moritz, T., Reda, D., Emanuele, N., Reaven, P. D., ... Huang, G. D. (2009). Glucose control and vascular complications in veterans with type 2 diabetes. New England Journal of Medicine, 360(2), 129-139. https://doi.org/10.1056/NEJMoa0808431

Glucose control and vascular complications in veterans with type 2 diabetes. / Duckworth, William; Abraira, Carlos; Moritz, Thomas; Reda, Domenic; Emanuele, Nicholas; Reaven, Peter D.; Zieve, Franklin J.; Marks, Jennifer B; Davis, Stephen N.; Hayward, Rodney; Warren, Stuart R.; Goldman, Steven; McCarren, Madeline; Vitek, Mary Ellen; Henderson, William G.; Huang, Grant D.

In: New England Journal of Medicine, Vol. 360, No. 2, 08.01.2009, p. 129-139.

Research output: Contribution to journalArticle

Duckworth, W, Abraira, C, Moritz, T, Reda, D, Emanuele, N, Reaven, PD, Zieve, FJ, Marks, JB, Davis, SN, Hayward, R, Warren, SR, Goldman, S, McCarren, M, Vitek, ME, Henderson, WG & Huang, GD 2009, 'Glucose control and vascular complications in veterans with type 2 diabetes', New England Journal of Medicine, vol. 360, no. 2, pp. 129-139. https://doi.org/10.1056/NEJMoa0808431
Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD et al. Glucose control and vascular complications in veterans with type 2 diabetes. New England Journal of Medicine. 2009 Jan 8;360(2):129-139. https://doi.org/10.1056/NEJMoa0808431
Duckworth, William ; Abraira, Carlos ; Moritz, Thomas ; Reda, Domenic ; Emanuele, Nicholas ; Reaven, Peter D. ; Zieve, Franklin J. ; Marks, Jennifer B ; Davis, Stephen N. ; Hayward, Rodney ; Warren, Stuart R. ; Goldman, Steven ; McCarren, Madeline ; Vitek, Mary Ellen ; Henderson, William G. ; Huang, Grant D. / Glucose control and vascular complications in veterans with type 2 diabetes. In: New England Journal of Medicine. 2009 ; Vol. 360, No. 2. pp. 129-139.
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N2 - BACKGROUND: The effects of intensive glucose control on cardiovascular events in patients with longstanding type 2 diabetes mellitus remain uncertain. METHODS: We randomly assigned 1791 military veterans (mean age, 60.4 years) who had a suboptimal response to therapy for type 2 diabetes to receive either intensive or standard glucose control. Other cardiovascular risk factors were treated uniformly. The mean number of years since the diagnosis of diabetes was 11.5, and 40% of the patients had already had a cardiovascular event. The goal in the intensive-therapy group was an absolute reduction of 1.5 percentage points in the glycated hemoglobin level, as compared with the standard-therapy group. The primary outcome was the time from randomization to the first occurrence of a major cardiovascular event, a composite of myocardial infarction, stroke, death from cardiovascular causes, congestive heart failure, surgery for vascular disease, inoperable coronary disease, and amputation for ischemic gangrene. RESULTS: The median follow-up was 5.6 years. Median glycated hemoglobin levels were 8.4% in the standard-therapy group and 6.9% in the intensive-therapy group. The primary outcome occurred in 264 patients in the standard-therapy group and 235 patients in the intensive-therapy group (hazard ratio in the intensive-therapy group, 0.88; 95% confidence interval [CI], 0.74 to 1.05; P = 0.14). There was no significant difference between the two groups in any component of the primary outcome or in the rate of death from any cause (hazard ratio, 1.07; 95% CI, 0.81 to 1.42; P = 0.62). No differences between the two groups were observed for microvascular complications. The rates of adverse events, predominantly hypoglycemia, were 17.6% in the standard-therapy group and 24.1% in the intensive-therapy group. CONCLUSIONS: 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. (ClinicalTrials.gov number, NCT00032487.)

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