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Intensive glucose-lowering therapy failed to improve CV outcomes
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Intensive glucose-lowering therapy was associated with improved adiponectin, lipid levels and in subfractions of LDL and HDL after 9 months among patients in the Veterans Affairs Diabetes Trial, according to researchers. However, data suggest that this therapy failed to lower cardiovascular outcomes.
As established in previous literature, the Veterans Affairs Diabetes Trial (VADT) was a randomized trial that compared the effects of intensive and standard glucose-lowering on new clinical macrovascular events among 1,791 military veterans who demonstrated a suboptimal response to therapy for type 2 diabetes. The 9-month follow-up enabled researchers to conduct a prospective analysis on the effects of the intensive therapy on lipoprotein particle profiles and inflammatory markers.
Juraj Koska, MD, of the department of medicine at Phoenix VA Health Care System, and colleagues examined a subgroup of the VADT patients (n=266) at baseline and after 9 months of therapy.
According to data, intensive glucose-lowering therapy decreased HbA1c (by a median of 2% vs. a median of 0.7% by standard treatment; P<.0001); increased BMI (4% vs. 1%; P<.001), total HDL (9% vs. 4%; P<.05), HDL (14% vs. 0%; P=.009), LDL (36% vs. 1%; P<.0001) and plasma adiponectin (130% vs. 80%; P<.01); and reduced triglycerides (–13% vs. 4%; P=.02) and small, dense LDL (−39% vs. −13%; P<.001).
Conversely, this therapy provided no effect on plasma apolipoproteins B100 and B48, C-reactive protein, interleukin-6, lipoprotein-associated phospholipase A2, myeloperoxidase, fibrinogen or plasminogen activator inhibitor 1, researchers wrote.
However, incident macrovascular events were associated with baseline levels of IL-6 (HR=1.33; 95% CI, 1.06-1.66), total LDL (HR=1.25; 95% CI, 1.01-1.55), ApoB-100 (HR=1.29; 95% CI, 1.01-1.65) and fibrinogen (HR=1.26; 95% CI, 1.01-1.57). Again, no changes were evident regarding any CV risk factors at 9 months.
Disclosure: The researchers report no relevant financial disclosures.
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