November - 20 - 2009
Recent investigations have shown that a more intensive approach to control blood glucose in type 2 diabetes patients has only a modest effect on reducing cardiovascular events. A meta-analysis of four clinical trials (ACCORD, ADVANCE, UKPDS and VADT) assessed the effects of more intensive, compared with less intensive, glucose control on the risk of cardiovascular events in patients with type 2 diabetes. The meta-analysis comprised 27,049 participants who experienced a total of 2,370 major cardiovascular events over 4.4 years. The risk of having a major cardiovascular event was reduced by 9% in patients who received the more intensive compared with the less intensive glycemic control (HR, 0.91; 95%CI, 0.84-0.99). In particular, the risk of nonfatal/fatal myocardial infarction was reduced by 15% in the more intensive versus the less intensive treatment group. However, the risk of severe hypoglycemia was increased by more than 2-fold (HR, 2.48; 95%CI, 1.91-3.21) in patients receiving the more intensive glycemic control. Thus, caution should be exercised in assigning intensive glucose-lowering strategies to patients with type 2 diabetes (Turnbull, F.M. et al. Diabetologia 2009, 52(11): 2288).