Despite conflicting studies, diabetes groups say good glycemic control still best course
THURSDAY, Dec. 18 (HealthDay News) -- While less strict blood sugar control may be appropriate for some diabetes patients, most should adhere to the target goal of less than 7 percent that's long been recommended for reducing the risk of diabetes-related complications.
That's the consensus from a joint statement released Wednesday by the American Diabetes Association, the American College of Cardiology and the American Heart Association.
The revised recommendations are based on the findings of three recently-released clinical trials that found no significant benefit and/or risks related to intensive glycemic (blood sugar) control and heart disease prevention in people with longstanding type 2 diabetes and high cardiovascular risk.
The three studies -- ACCORD, ADVANCE and VADT -- produced conflicting results. The ACCORD study was halted early because of an increased death rate among patients in the intensive glycemic control group. The two other studies found that intensive glycemic control didn't increase the risk of death but also didn't provide any significant cardiovascular benefit.
"Given the confusion created by these conflicting results, we thought it imperative to review our recommendations for all people with diabetes," Dr. Jay Skyler, head of the recommendation writing group, said in a joint news release from the organizations.
"What we conclude is that for most people with diabetes, there's no need to change treatment goals in light of these findings and many reasons to continue to strive for good glycemic control. But for some people with type 2 diabetes, depending upon their history and current medical condition, it may be wise to make adjustments," Skyler said.
He and his colleagues said the revised recommendations are consistent with prior guidelines that blood sugar goals should be matched to individual patients, based on their medical history.
Study data also suggests that good glycemic control may provide a cardiovascular benefit for people who've had diabetes for a short period of time and have no known cardiovascular disease.
"The lack of significant reduction in CVD (cardiovascular disease) events with intensive glycemic control should not lead clinicians to abandon the general target of AIC (a measure of blood glucose level over the prior 2 to 3 months) levels of less than 7 percent, and thereby discount the benefit of good control on what are serious and debilitating microvascular complications," the joint statement said.
However, less stringent AIC goals should be considered for diabetes patients with a "history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, and those with longstanding diabetes in whom the general goal is difficult to attain despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose lowering agents including insulin."
The recommendations were published online in the journals of each of the three organizations.
The U.S. National Diabetes Education Program has more about diabetes control.
-- Robert Preidt
SOURCE: American Diabetes Association, American College of Cardiology and American Heart Association, joint news release, Dec. 17, 2008
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