BACKGROUND: The goal of the VA Diabetes Trial (VADT) was to determine the effect of intensive glucose control on macrovascular events in subjects with difficult-to-control diabetes. No significant benefit was found. This report examines predictors of the effect of intensive therapy on the primary outcome in this population. METHODS: This trial included 1791 subjects. Baseline cardiovascular risk factors were collected by interview and the VA record. The analyses were done by intention to treat. FINDINGS: Univariate analysis at baseline of predictors of a primary cardiovascular (CV) event included a prior CV event, age, insulin use at baseline, and duration of diagnosed diabetes (all P < .0001). Multivariable modeling revealed a U-shaped relationship between duration of diabetes and treatment. Modeled estimates for the hazard ratios (HRs) for treatment show that subjects with a short duration (3 years or less) of diagnosed diabetes have a nonsignificant increase in risk (HR > 1.0) after which the HR is below 1.0. From 7 to 15 years' duration at entry, subjects have HRs favoring intensive treatment. Thereafter the HR approaches 1.0 and over-21-years' duration approaches 2.0. Duration over 21 years resulted in a HR of 1.977 (CI 1.77-3.320, P < .01). Baseline c-peptide levels progressively declined up to 15 years and were stable subsequently. INTERPRETATION: In difficult-to-control older subjects with type 2 DM, duration of diabetes altered the response to intensive glucose control. Intensive therapy may reduce CV events in subjects with a duration of 15 years or less and may increase risks in those with longer duration. Published by Elsevier Inc.
RCT Entities:
BACKGROUND: The goal of the VA Diabetes Trial (VADT) was to determine the effect of intensive glucose control on macrovascular events in subjects with difficult-to-control diabetes. No significant benefit was found. This report examines predictors of the effect of intensive therapy on the primary outcome in this population. METHODS: This trial included 1791 subjects. Baseline cardiovascular risk factors were collected by interview and the VA record. The analyses were done by intention to treat. FINDINGS: Univariate analysis at baseline of predictors of a primary cardiovascular (CV) event included a prior CV event, age, insulin use at baseline, and duration of diagnosed diabetes (all P < .0001). Multivariable modeling revealed a U-shaped relationship between duration of diabetes and treatment. Modeled estimates for the hazard ratios (HRs) for treatment show that subjects with a short duration (3 years or less) of diagnosed diabetes have a nonsignificant increase in risk (HR > 1.0) after which the HR is below 1.0. From 7 to 15 years' duration at entry, subjects have HRs favoring intensive treatment. Thereafter the HR approaches 1.0 and over-21-years' duration approaches 2.0. Duration over 21 years resulted in a HR of 1.977 (CI 1.77-3.320, P < .01). Baseline c-peptide levels progressively declined up to 15 years and were stable subsequently. INTERPRETATION: In difficult-to-control older subjects with type 2 DM, duration of diabetes altered the response to intensive glucose control. Intensive therapy may reduce CV events in subjects with a duration of 15 years or less and may increase risks in those with longer duration. Published by Elsevier Inc.
Authors: Rozalina G McCoy; Kasia J Lipska; Xiaoxi Yao; Joseph S Ross; Victor M Montori; Nilay D Shah Journal: JAMA Intern Med Date: 2016-07-01 Impact factor: 21.873
Authors: Marinella Ruospo; Valeria M Saglimbene; Suetonia C Palmer; Salvatore De Cosmo; Antonio Pacilli; Olga Lamacchia; Mauro Cignarelli; Paola Fioretto; Mariacristina Vecchio; Jonathan C Craig; Giovanni Fm Strippoli Journal: Cochrane Database Syst Rev Date: 2017-06-08
Authors: Aramesh Saremi; Dawn C Schwenke; Gideon Bahn; Ling Ge; Nicholas Emanuele; Peter D Reaven Journal: Metabolism Date: 2014-10-17 Impact factor: 8.694
Authors: Jea Young Min; Amber J Hackstadt; Marie R Griffin; Robert A Greevy; Jonathan Chipman; Carlos G Grijalva; Adriana M Hung; Christianne L Roumie Journal: Diabetes Obes Metab Date: 2019-08-29 Impact factor: 6.577
Authors: Dawn Konrad-Martin; Curtis J Billings; Garnett P McMillan; Daniel McDermott; Jane Gordon; Donald Austin; Marilyn F Dille Journal: Ear Hear Date: 2016 May-Jun Impact factor: 3.570
Authors: Shaista Malik; Yanglu Zhao; Matthew Budoff; Khurram Nasir; Roger S Blumenthal; Alain G Bertoni; Nathan D Wong Journal: JAMA Cardiol Date: 2017-12-01 Impact factor: 14.676