30 Dec Tight Glycemic Control Not Best For All Patients With Diabetes
MedicalResearch.com Interview with:
Aramesh Saremi MD
Phoenix VA Health Care System
Health Research Scientist
Phoenix, AZ 85012-1892
Medical Research: What is the background for this study? What are the main findings?
Dr. Saremi: Our study was a post-hoc analysis of the data that was available from VA cooperative study, the Veterans Affair Diabetes Trial (VADT). The VADT was one of the recent landmark studies examining the effect of intensive glycemic control on cardiovascular events in older adults with type 2 diabetes.
The main finding in the VADT and other two other landmark studies (ACCORD and ADVANCE ) was that intensive glycemic control does not reduce cardiovascular disease events in people with type 2 diabetes of moderate to long duration. However, our subsequent post-hoc analysis suggests that intensive glycemic control was associated with reduced risk of cardiovascular events in Hispanics, but not in non-Hispanic Whites or Blacks.
Medical Research: What should clinicians and patients take away from your report?
Dr. Saremi: Well, as we now know, tight glycemic control is not for everyone. Our study points out that the risk-benefit ratio for intensive diabetes treatment should be evaluated in different race/ethnic populations. An important take away from our study was that while receiving similar access to healthcare and diabetes guidance, Hispanics not only respond well to glucose lowering efforts, but may also gain additional benefit with respect to its consequences on cardiovascular disease events.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Saremi: The VADT was not designed to investigate the effect of intensive glycemic control in race/ethnic subgroups, as a result the sample size for this post-hoc analysis of race/ethnicity groups was relatively small. More research is needed and our results needs to be confirmed in other well powered studies in different populations.
Also, further work will be needed to clarify the potential mechanisms accounting for the apparent “enhanced cardiovascular response” to glucose lowering therapy in Hispanics.
Note: These statements do not represent views of the Department of Veterans Affair or the United States Government.
Citation:
The Effect of Intensive Glucose Lowering Therapy Among Major Racial/Ethnic Groups in the Veterans Affairs Diabetes Trial
Aramesh Saremi, Dawn C. Schwenke,Gideon Bahn,Ling Ge,Nicholas Emanuele,Peter D. Reaven, for thr VADT Investigators
Metabolism Volume 64, Issue 2, February 2015, Pages 218–225
Last Updated on December 30, 2014 by Marie Benz MD FAAD