The duration of diabetes affects the response to intensive glucose control in type 2 subjects

The VA Diabetes Trial

William C. Duckworth, Carlos Abraira, Thomas E. Moritz, Stephen N. Davis, Nicholas Emanuele, Steven Goldman, Rodney Hayward, Grant D. Huang, Jennifer B Marks, Peter D. Reaven, Domenic J. Reda, Stuart R. Warren, Franklin J. Zieve

Research output: Contribution to journalArticle

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Abstract

Background: The goal of the VA Diabetes Trial (VADT) was to determine the effect of intensive glucose control on macrovascular events in subjects with difficult-to-control diabetes. No significant benefit was found. This report examines predictors of the effect of intensive therapy on the primary outcome in this population. Methods: This trial included 1791 subjects. Baseline cardiovascular risk factors were collected by interview and the VA record. The analyses were done by intention to treat. Findings: Univariate analysis at baseline of predictors of a primary cardiovascular (CV) event included a prior CV event, age, insulin use at baseline, and duration of diagnosed diabetes (all P<.0001). Multivariable modeling revealed a U-shaped relationship between duration of diabetes and treatment. Modeled estimates for the hazard ratios (HRs) for treatment show that subjects with a short duration (3 years or less) of diagnosed diabetes have a nonsignificant increase in risk (HR >1.0) after which the HR is below 1.0. From 7 to 15 years' duration at entry, subjects have HRs favoring intensive treatment. Thereafter the HR approaches 1.0 and over-21-years' duration approaches 2.0. Duration over 21 years resulted in a HR of 1.977 (CI 1.77-3.320, P<.01). Baseline c-peptide levels progressively declined up to 15 years and were stable subsequently. Interpretation: In difficult-to-control older subjects with type 2 DM, duration of diabetes altered the response to intensive glucose control. Intensive therapy may reduce CV events in subjects with a duration of 15 years or less and may increase risks in those with longer duration.

Original languageEnglish
Pages (from-to)355-361
Number of pages7
JournalJournal of Diabetes and its Complications
Volume25
Issue number6
DOIs
StatePublished - Nov 1 2011

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Glucose
Interviews
Insulin
Peptides
Therapeutics
Population

Keywords

  • Intensive glucose control
  • Macrovascular risk and events
  • Type 2 diabetes

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

The duration of diabetes affects the response to intensive glucose control in type 2 subjects : The VA Diabetes Trial. / Duckworth, William C.; Abraira, Carlos; Moritz, Thomas E.; Davis, Stephen N.; Emanuele, Nicholas; Goldman, Steven; Hayward, Rodney; Huang, Grant D.; Marks, Jennifer B; Reaven, Peter D.; Reda, Domenic J.; Warren, Stuart R.; Zieve, Franklin J.

In: Journal of Diabetes and its Complications, Vol. 25, No. 6, 01.11.2011, p. 355-361.

Research output: Contribution to journalArticle

Duckworth, WC, Abraira, C, Moritz, TE, Davis, SN, Emanuele, N, Goldman, S, Hayward, R, Huang, GD, Marks, JB, Reaven, PD, Reda, DJ, Warren, SR & Zieve, FJ 2011, 'The duration of diabetes affects the response to intensive glucose control in type 2 subjects: The VA Diabetes Trial', Journal of Diabetes and its Complications, vol. 25, no. 6, pp. 355-361. https://doi.org/10.1016/j.jdiacomp.2011.10.003
Duckworth, William C. ; Abraira, Carlos ; Moritz, Thomas E. ; Davis, Stephen N. ; Emanuele, Nicholas ; Goldman, Steven ; Hayward, Rodney ; Huang, Grant D. ; Marks, Jennifer B ; Reaven, Peter D. ; Reda, Domenic J. ; Warren, Stuart R. ; Zieve, Franklin J. / The duration of diabetes affects the response to intensive glucose control in type 2 subjects : The VA Diabetes Trial. In: Journal of Diabetes and its Complications. 2011 ; Vol. 25, No. 6. pp. 355-361.
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AU - Warren, Stuart R.

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