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Comorbidity Affects Outcome of Glycemic Control in Diabetes

Cardiovascular benefits found to be fewer for patients with high burden of other diseases

TUESDAY, Dec. 15 (HealthDay News) -- The cardiovascular benefits of intensive glycemic control in type 2 diabetes patients are reduced if they have high levels of comorbidity, according to a study in the Dec. 15 issue of the Annals of Internal Medicine.

Sheldon Greenfield, M.D., of the University of California in Irvine, and colleagues conducted a five-year longitudinal study of 2,613 patients with type 2 diabetes recruited from 101 diabetes outpatient clinics and 103 general practitioners' clinics who completed a questionnaire and were categorized according to their total comorbidity into high and low-to-moderate subgroups.

Among patients in the low-to-moderate subgroup, there was an association between attaining a hemoglobin A1c target of 6.5 percent or below and reduced five-year incidence of cardiovascular events, but this was not the case for the high-comorbidity subgroup, the researchers found. The results were similar for reductions of baseline hemoglobin A1c to 7.0 percent.

"Any reduction of risk for cardiovascular events associated with tight glycemic control may not be uniform across patient subgroups," the authors write. "Only clinical trials that include relatively young and healthy diabetic patients can causally demonstrate that patients with low levels of comorbidity can benefit from attaining tight glycemic control. However, our study suggests that intensive glucose control may not have the expected protective effect on cardiovascular event risk for a substantial group of patients."

The study was funded by Pfizer of Italy.

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