Damage may already be done in advanced diabetes

NEW YORK (Reuters Health) - For men with long-standing, poorly controlled diabetes, intensive efforts to regulate glucose levels have little effect on rates of heart attacks or stroke, complications such as eye damage, or death, according to a report published Wednesday.

Previous studies indicated a delayed benefit from intensive glucose control in young patients with type 1 diabetes, but recent studies in older patients with more advanced disease failed to detect any advantages to more aggressive treatment, the researchers explain in their online report in the New England Journal of Medicine.

The current study included 1791 military veterans with long-standing type 2 diabetes and high A1C readings — a measure of long-term glucose levels. Half the subjects were randomly assigned to intensive treatment, with the goal of reducing their A1C by 1.5 percentage points compared with the standard-therapy group.

During the 7.5-year trial, average A1C levels were 8.4 percent in the standard group and 6.9 percent in the intensive group, Dr. William Duckworth, at the Phoenix VA Health Care System in Arizona, and fellow investigators report.

However, there was no significant difference between groups in the primary outcomes — time to occurrence of heart attack, stroke, death from cardiovascular causes, heart failure, vascular disease requiring surgery, inoperable coronary disease, or amputation due to gangrene.

Moreover, mortality rates and the incidence of serious complications, major kidney impairment, and nerve damage were similar with the two treatments.

“Intensive glycemic control earlier in the disease course may produce benefit,” Duckworth’s team suggests. For advanced diabetes, however, treating high blood pressure and high cholesterol levels and other risk factors would seem to be the best approach to reducing heart-related illnesses and deaths.

SOURCE: New England Journal of Medicine, January 8, 2009, online December 17, 2008.


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