Diabetes and cardiovascular disease: The role of glycemic control

Over the past decade, clinical practice guidelines have lowered their glycemic targets for people with type 2 diabetes. However, recent randomized controlled trials (ACCORD, ADVANCE, and VADT) demonstrate that intensive glycemic targets do not reduce cardiovascular risk among higher-risk individuals over a period of 3.5 to 5 years. Thus, targeting a hemoglobin A1c below 6% among high-risk patients should not be recommended. However, the 10-year post-trial monitoring of the UKPDS demonstrated cardiovascular benefit of intensive glycemic control among those with newly diagnosed type 2 diabetes over a median follow-up of 17 years. This raises the possibility that cardiovascular benefits of glycemic control require many years to manifest and early intervention may carry greater benefit. Therefore, these recent trials continue to support the recommended hemoglobin A(1c) target of below 7% to reduce microvascular complications in type 2 diabetes and perhaps macrovascular complications in those with newly diagnosed diabetes.