Implications of new diabetes treatment trials: should current clinical practice be altered?

Patients with type 2 diabetes mellitus are at increased risk for complications related to both microvascular and macrovascular events. Although glycemic control has been shown to lower the risk of microvascular events, the effect of intensive glycemic control on macrovascular outcomes is less clear. Recently, 3 large randomized controlled trials (Action to Control Cardiovascular Risk in Diabetes [ACCORD], Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation [ADVANCE], and the Veterans Affairs Diabetes Trial [VADT]) have been published to assess the effect of intensive glucose-lowering efforts on macrovascular outcomes, including myocardial infarction, stroke, and death. This article highlights the similarities and differences between the 3 trials with an emphasis on their impact on patient care.