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Glycemic Control Approaches Lead to Similar Outcomes

Study compared prandial, basal strategies on cardiovascular events in type 2 diabetics after myocardial infarction

MONDAY, Mar. 2 (HealthDay News) -- Different approaches to glycemic control in type 2 diabetics following myocardial infarction were associated with similar risk of later cardiovascular events, according to research published in the March issue of Diabetes Care.

Itamar Raz, M.D., of the Hadassah Hospital in Jerusalem, Israel, and colleagues analyzed data from 1,115 adults with type 2 diabetes and a recent history of acute myocardial infarction who were randomized to a strategy targeting postprandial glycemia using premeal insulin lispro (Humalog, Eli Lilly) three times a day (the prandial group), or a strategy targeting fasting glycemia (the basal group) with twice daily NPH (Humulin, Eli Lilly) or once-daily insulin glargine (Lantus, sanofi-aventis). The researchers assessed time until first combined adjudicated cardiovascular event, which included cardiovascular death and coronary revascularization.

The trial was halted early, with similar risks of first events in the groups, the report indicates. Mean A1C did not differ between the groups. The prandial group, however, had consistently lower postprandial glycemia, and the basal group had generally lower fasting glycemia.

"The null results…may be explained by the advanced state of cardiovascular disease in the patients studied. Retarding the progression of advanced atherosclerosis may be very difficult, similar to observations with advanced microvascular complications. Many cardiovascular events occurred early in the course of HEART2D, indicating extension or progression of pre-existing disease," the authors conclude.

The study was sponsored by Eli Lilly, and the co-authors were employees of Lilly or listed other relationships with the company. Several co-authors disclosed relationships with sanofi-aventis.

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