CV

Abbreviations. DIGAMI, Diabetes Insulin Glucose Acute Myocardial Infarction; UKPDS, U.K. Prospective Diabetes study; VACSDM, Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type 2 Diabetes.

aSu, sulfonylurea.

Abbreviations. DIGAMI, Diabetes Insulin Glucose Acute Myocardial Infarction; UKPDS, U.K. Prospective Diabetes study; VACSDM, Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type 2 Diabetes.

patients with type 2 diabetes with high risk for cardiovascular disease. Ten thousand patients will be studied comparing an HbA1c of < 6.0 % versus < 7.5% as well as studies on controlling blood pressure and lipids. The results of this important study should answer this important question. In the meanwhile it is essential to continue to control the blood glucose as close to normal as possible and to be aggressive about risk factor reduction.

The recent EDIC trial data is a landmark trial in type 1 diabetes on the effects of tight glycemic control and cardiovascular disease. The 11th year follow-up data showed a 42% reduction in nonfatal MI, stroke and a 57% reduction in cardiovascular death in the intensively treated DCCT group compared to conventional treatment. This result strongly suggests that the tight glycemic control during the DCCT trial with a mean AIC of 6.5% had sustained benefits even though the glycemic control was not maintained during the EDIC trial (48).

A recent meta-analysis of randomized trials of glycemic control and macrovascular disease in type 1 and type 2 diabetes showed a reduction in cardiac and peripheral vascular events with type 1 diabetes and a reduction in stroke and peripheral vascular events in type 2 diabetes with better control. Thus it appears effects of glucose control on specific manifestations of macrovascular disease may be different between type 1 and type 2 diabetes (49).

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