Strict Blood Sugar Control Lowers Heart Risk with Diabetes

Patients with type 2 diabetes who keep their blood sugar levels tightly controlled for many years may have better heart health, according to new research in the June 4 issue of the New England Journal of Medicine.

Researchers found that many years of keeping blood sugar levels under good control can reduce the risk of suffering a heart attack, stroke, heart failure, or amputation by about 17%.
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“Taken together with findings from other large studies, we see that controlling blood sugar in diabetes can indeed decrease cardiovascular risk, though we continue to see no effect on risk of dying during the same time period,” lead study author Rodney Hayward, MD, of the VA Ann Arbor Healthcare System and the University of Michigan Medical School said in a press release.

“This finding reinforces the importance of combining good blood sugar control with control of other cardiovascular risk factors for a combined effect,” he said.

Hayward and his colleagues conducted a new analysis of data from nearly 1,800 veterans enrolled in the Veterans Affairs Diabetes Trial (VADT) who were randomized to receive treatment to help them achieve tight blood sugar control or standard care. Those who received intensive treatment got down to a median 6.9% hemoglobin A1c during 5.6 years of active treatment in the trial, compared with 8.4% in the group who received standard therapy.

In the original VADT study, patients did not show any significant reduction in major cardiovascular events related to tight glucose control after 5 to 6 years of follow-up.

The cardiovascular benefit investigators found associated with intensive glucose lowering emerged after longer follow-up—a median of 9.8 years.

Results suggested that a long-term average of about 8% A1C hemoglobin was enough to achieve most of the cardiovascular benefit, but that many patients can be safely lowered to around 7%.

The authors emphasized that their findings should not be used to justify an A1C target of 7% for all patients with diabetes across the board. Instead, they stress that health care providers should also consider the patient’s risk of cardiac events, of low blood sugar reactions, and what additional medications would be needed to lower A1C further.

“Once someone has his or her A1C around 8%, we need to individualize treatment to the patient, balancing his or her individual cardiovascular risk based on personal and family history, his or her age and life expectancy, smoking history, and medication side effects,” Hayward said. “If you want to determine what the best A1C number is for you, and when should take another medication to lower it, you should decide with your doctor.”

—Colleen Mullarkey

Reference

Hayward RA, Reaven PD, Wiitala WL, Bahn GD, Reda DJ, Ge L, et al. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015 Jun 4; 372(23):2197-2206. doi: 10.1056/NEJMoa1414266.