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WEDNESDAY, June 5, 2019 (HealthDay News) – Type 2 diabetes is a known risk factor for heart disease, and researchers have estimated that a very strict blood sugar control for five years could reduce the risk of heart disease for years to come.
But a new 15-year follow-up study revealed that this was not the case. The findings suggest that it might be more important to control other risk factors for heart disease, such as high blood pressure, cholesterol, and unhealthy weight.
"Lowering glucose has a modest advantage, but it's not enough – we need to address all other cardiovascular risk factors," said Dr. Peter Reaven, lead author of the study. He is a physician member of the Phoenix Veterans Affairs Health System in Arizona.
Reaven pointed out that these results apply to this particular population – people with type 2 diabetes for more than 10 years on average before the start of the study. Their average age was about 60 years old and the study group was composed almost exclusively of men.
It is therefore not yet known what the results might be if a blood glucose lowering intervention was initiated shortly after the diagnosis of type 2 diabetes. It is also not known whether these results apply to people with diabetes mellitus. type 1.
The initial phase of the study included nearly 1,800 people. They were randomly selected to receive either standard diabetes treatment or intensive treatment to reduce blood sugar levels.
Both groups received the same medications. The difference was in the dosage. People in the intensive group received enough drugs to lower their A1C hemoglobin level below 7%. Hemoglobin A1C is a blood test that provides an estimate of average blood glucose.
An A1C less than 5.9% is considered normal. The researchers aimed to reduce the intensive treatment group to less than 7%. Reaven said the initial average HbA1c for the entire group was about 9%.
During the intervention portion of the study, the group receiving usual care lowered their A1C level to 8.4%. The intensive group had an average HbA1C of 6.9%. The intervention lasted nearly six years.
About 10 years after the start of the study, researchers found a 17% decrease in the risk of heart disease and stroke.
"We wanted to know if there was a continuing benefit, an" inheritance "effect," explained Reaven. And, at least in the short term, it appeared that this might be the case.
But the 15-year follow-up revealed no statistically significant difference in the rate of heart attacks and strokes, or deaths.
"It was a fairly definitive badessment, and in this group of elderly patients with type 2 diabetes, there is no evidence of an inheritance effect." "said Reaven. "Our data suggests that for the reduction of blood glucose to have a continuous benefit, it must be maintained."
Since the intervention phase of the study, new drugs – some of which have been specifically shown to reduce the risk of heart disease – have been introduced for type 2 diabetes. It is unclear what could be Long-term effect of these drugs, nor whether these new drugs have an inheritance effect.
The results of the study were published on June 6 in the New England Journal of Medicine.
Dr. Kasia Lipska of the Yale School of Medicine is co-author of an editorial in the same issue of the journal.
"We have learned over time that reducing blood sugar is important for reducing cardiovascular risk, and with new drugs with different mechanisms of action, the benefits of cardiovascular disease are fast," she said. .
But she said it was essential to control other risk factors for heart disease and stroke. "Very strict control of glucose for cardiovascular disease is not the best way to reduce the risk of smoking, controlling blood pressure, taking statins [to lower cholesterol] are known to reduce the risk of cardiovascular disease, "said Lipska.
This does not mean that controlling blood sugar is not important, that's right. But there must be a balance. People should not try to reduce their blood sugar levels to the point of ending up having a dangerous episode of hypoglycemia.
"Patients should talk to their doctor about what's right for them," she advised.
Dr. Gerald Bernstein is program coordinator at the Diabetes Institute at Lenox Hill Hospital in New York. Like the authors of the study, he pointed out that the widespread use of drugs for hypertension and cholesterol may have had an impact on the potential benefits of a drug. drop in blood sugar. He said the results of this study should not change the current management of blood glucose.
"The result is that glycemic control is better than not," said Bernstein.
More information
Learn more about American Diabetes Association Type 2 Diabetes Management.
SOURCES: Peter Reaven, MD, Staff Physician, Phoenix Veterans Affairs Health Care System and University of Arizona; Kasia Lipska, MD, Assistant Professor of Medicine, Yale School of Medicine, New Haven, Connecticut; Gerald Bernstein, MD, Program Coordinator, Friedman Diabetes Institute, Lenox Hill Hospital, New York; June 6, 2019, New England Journal of Medicine
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