Effect of Strict Diabetes Control on Heart Still Unclear

Reviews show it wasn't to blame for excess deaths in one trial, but when therapy starts could be key

By Amanda Gardner
HealthDay Reporter

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TUESDAY, June 9 (HealthDay News) -- Reviews of two large diabetes trials show that the relationship between tight blood sugar control and the risk of heart trouble is still far from certain.

The first analysis found that a troubling number of deaths seen in a large diabetes trials appears not to have been caused by low blood glucose levels, as originally thought.

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It's still not completely clear, however, what factors might explain the 451 deaths that occurred in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, which was shut down early after researchers found a 20 percent increased risk of death among those in the more intensive blood sugar control group.

Meanwhile, analyses of another trial, the VA Diabetes (VADT) trial, found that intensive blood sugar control that's begun many years after diagnosis may actually do more harm than good when it comes to cardiovascular problems.

Both sets of analyses, which were presented Tuesday during a teleconference at the American Diabetes Association (ADA) annual meeting in New Orleans, suggest that diabetes treatment needs to be tailored to the particular needs and characteristics of each patient.

"Treatment should be individualized," Dr. William C. Duckworth, VADT co-chair and director of diabetes research at the Carl T. Hayden VA Medical Center in Phoenix, said during the Tuesday teleconference. "Type 2 diabetes is an extremely heterogenous disease, so if you treat different populations or different groups within the population you're studying you may get different results."

"We are withholding specific recommendations, but there may be potentially different glucose-control targets for different groups of people," added Dr. Matthew C. Riddle, member of the ACCORD Glycemia Management Group and professor of medicine at Oregon Health Science University. "If we can objectively identify which individuals fall into which groups, that would be a big step forward."

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