Benefit/Harm of Intensive Glucose Control in Type 2

http://www.diabetes.org/diabetesnewsarticle.jsp?storyId=20275395&filename=20090609/comtex20090609iw00000043KEYWORDMissingEDIT.xml

or

http://tinyurl.com/knclpt

(excerpt)

Factors Affecting Benefit/Harm of Intensive Glucose Control in Type 2
Diabetes Reported-Initiation of Intensive Control in First 15 Years
After Diagnosis Reduces CV Events Initiation of Intensive Control
After 16-20 Years - No Benefit; Initiation After 20


NEW ORLEANS, LA, Jun 09, 2009 (MARKETWIRE via COMTEX) -- Factors
affecting whether intensive glucose control is likely to reduce or
increase the risk of cardiovascular events, including death, based on
evidence in the VA Diabetes Trial, were reported in a symposium here
today at the American Diabetes Association's 69th Scientific
Sessions.

"We found that initiation of intensive control in the first 15 years
after a diagnosis of type 2 diabetes reduced the risk of
cardiovascular events, including mortality, but initiation 16 to 20
years after diagnosis yielded no such benefit," said William C.
Duckworth, MD, Director of Diabetes Research, Carl T. Hayden VA
Medical Center in Phoenix, Professor of Clinical Medicine, University
of Arizona, and Co-Chair of the VA Diabetes Trial (VADT), in a recent
interview.

"Further, initiation of intensive control 20 or more years after
diagnosis increased the risk of cardiovascular events in the
population studied in this trial," said Duckworth. These duration
effects were not affected by age, despite the fact that age itself is
an independent risk for CV events.

In contrast to the VADT report last year showing that intensive
control did not have a statistically significant effect on reducing
cardiovascular (CV) events, the subanalyses presented here clearly
showed which patients benefited from intensive glucose control and
which patients did not.

The effect of duration impact was complex. According to the research,
the risk of having a primary CV event (i.e., heart attack or stroke)
among people who had diabetes for 10 to 15 years was reduced 40% if
they were on intensive glucose control. At the other end of the
spectrum, if diabetes had been present for more than 21 years, the
risk of primary CV events in patients on intensive control more than
doubled.

"Unless other factors are present that would contraindicate intensive
treatment, such as hypoglycemia, intensive control is appropriate in
the first 15 years after diagnosis," said Duckworth. "However,
intensive treatment should not be initiated if the individual has
already had diabetes for 20 years." He said it is unknown whether a
person who has already been on intensive treatment for many years can
safely continue it beyond the 20-year mark.

Other major risk factors potentially precipitating a primary CV event
or total mortality were hypoglycemia, a previous CV event, older age
and impaired kidney function.

Duckworth and a colleague described in detail two factors -- HDL
levels and hypoglycemia levels -- that could decrease or increase,
respectively, the risk of CV events in people with type 2 diabetes, as
well as pointed out areas where questions remain.

HDL Levels

"The main factor decreasing mortality risk in the study was the
individual's level of HDL -- the good cholesterol fraction," explained
Duckworth. "There was an 80% decrease in risk of CV events, including
mortality, for every 10 mg increase in HDL above each individual's
baseline, a 50% decrease in risk of a first primary CV event for every
10 mg increase in HDL, and a 55% decrease in risk of all-cause
mortality for every 10 mg increase in HDL." He said this is comparable
to what has been seen in epidemiologic studies of people without
diabetes. HDL levels can be raised through regular exercise and with
certain medications.

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