No MI rate advantage for aggressive T2DM glucose control

(HealthDay)—In patients with type 2 diabetes, more aggressive glucose-control strategies have variable short-term effects on microvascular complications, but they do not reduce the rate of myocardial infarction over four years of follow-up, according to a study published online July 22 inDiabetes Care.

Romain Neugebauer, Ph.D., of Kaiser Permanente in Oakland, Calif., and colleagues conducted a cohort study involving 58,000 adults with type 2 diabetes who had A1C <7 percent while taking two or more oral agents or basal insulin; subsequent A1C levels increased from ?7 percent to 8.5 percent. The effect of progressively more intensifiedglucose-controlstrategies initiated at A1C of ?7, ?7.5, ?8, or ?8.5 percent with subsequent control for treatment adherence was assessed.

The researchers found that, after multivariable adjustment, including for age, sex, race/ethnicity, comorbidities, blood pressure, lipids, andbody mass index, increasingly more aggressive strategies for glucose control were associated with reduced onset or worsening of albuminuria. However, progressively aggressive glucose-control strategies were not linked with changes in major clinical outcomes during four years of follow-up, such as reductions in the occurrence ofmyocardial infarctionor preservation of renal function.

"In a large representative cohort of adults with type 2 diabetes, more aggressive glucose-control strategies have mixed short-term effects onmicrovascular complicationsand do not reduce the myocardial infarction rate over four years of follow-up," the authors write. "These findings are consistent with the results of recent clinical trials, but confirmation over longer periods of observation is needed."

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