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Intensive Glucose Therapy May Not Be Best in Type 2 Diabetes

Such therapy in those at increased cardiovascular risk related to higher risk of mortality

WEDNESDAY, March 2 (HealthDay News) -- Therapy designed to intensively lower glucose in people with type 2 diabetes and cardiovascular risk factors appears to lower the risk of nonfatal heart attack but is associated with an increased risk for all-cause mortality, according to research published in the March 3 issue of the New England Journal of Medicine.

Hertzel C. Gerstein, M.D., of McMaster University in Hamilton, Canada, and colleagues on the Action to Control Cardiovascular Risk in Diabetes Study Group randomly assigned subjects with type 2 diabetes and cardiovascular disease or additional cardiovascular risk factors to either intensive glucose lowering therapy or standard therapy, targeting glycated hemoglobin levels below 6 percent and between 7 and 7.9 percent, respectively. After a mean 3.7 years, intensive therapy was terminated because of higher mortality in that group and the target glycated hemoglobin level was 7 to 7.9 percent for all participants.

Before intensive therapy termination, the researchers found no significant difference between the two groups in composite nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes; however, the intensive-therapy group experienced fewer nonfatal myocardial infarctions, but greater all-cause mortality -- primarily cardiovascular causes (hazard ratios, 0.79 and 1.21, respectively). After termination of the intensive intervention, the median glycated hemoglobin level in the intensive-therapy group rose from 6.4 to 7.2 percent, and rates of severe hypoglycemia and other adverse events as well as use of glucose-lowering medications were similar in the two groups.

"As compared with standard therapy, the use of intensive therapy for 3.7 years to target a glycated hemoglobin level below 6 percent reduced five-year nonfatal myocardial infarctions but increased five-year mortality. Such a strategy cannot be recommended for high-risk patients with advanced type 2 diabetes," the authors write.

Several authors disclosed financial relationships with pharmaceutical and/or medical device companies, including several that provided study medications, equipment, or supplies.

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