Nasrin Azad1,2, Lily Agrawal3,2, Gideon Bahn2, Nicholas V Emanuele3,2, Peter D Reaven4, Rodney Hayward5, Domenic Reda. 1. Endocrinology Section, Edward Hines, Jr. VA Hospital, Hines, IL nasrin.azad@va.gov. 2. Cooperative Studies Program Coordinating Center, Hines, IL. 3. Endocrinology Section, Edward Hines, Jr. VA Hospital, Hines, IL. 4. Endocrinology Section, Carl T. Hayden VA Medical Center, Phoenix, AZ. 5. Ann Arbor VA Healthcare System, Ann Arbor, MI.
Abstract
OBJECTIVE: The objective of this study was to assess the long-term role of intensive glycemic control (INT) compared with standard glycemic control in accumulated eye procedures in patients with advanced diabetes. RESEARCH DESIGN AND METHODS: We compared the effect of treatment assignment on the accumulated number of eye procedures during the intervention period of the Veteran Affairs Diabetes Trial (VADT) (2000-2008) (median follow-up 5.6 years), the interim VADT follow-up study (2000-2013), and the full 17 years of VADT follow-up (2000-2017). We further analyzed data using various cardiovascular markers in two models. Model I included total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure, and BMI. Model II included these covariates plus age and diabetic retinopathy (DR) severity score at baseline of the original trial. RESULTS: The final analysis of the data showed a mild but nonsignificant increase in number of procedures and in retinal or retinal plus cataract surgery during the three periods of the study. CONCLUSIONS: We found no significant benefit of INT during the original trial period in eye-related procedures, such as various procedures for DR, or during the 17 years of follow-up in cataract surgery. However, after adjusting data for some known vascular markers, the increase in the number of eye procedures with INT becomes more prevalent. This finding indicates that INT might not have a protective role in events requiring surgery in individuals with advanced diabetes.
OBJECTIVE: The objective of this study was to assess the long-term role of intensive glycemic control (INT) compared with standard glycemic control in accumulated eye procedures in patients with advanced diabetes. RESEARCH DESIGN AND METHODS: We compared the effect of treatment assignment on the accumulated number of eye procedures during the intervention period of the Veteran Affairs Diabetes Trial (VADT) (2000-2008) (median follow-up 5.6 years), the interim VADT follow-up study (2000-2013), and the full 17 years of VADT follow-up (2000-2017). We further analyzed data using various cardiovascular markers in two models. Model I included total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure, and BMI. Model II included these covariates plus age and diabetic retinopathy (DR) severity score at baseline of the original trial. RESULTS: The final analysis of the data showed a mild but nonsignificant increase in number of procedures and in retinal or retinal plus cataract surgery during the three periods of the study. CONCLUSIONS: We found no significant benefit of INT during the original trial period in eye-related procedures, such as various procedures for DR, or during the 17 years of follow-up in cataract surgery. However, after adjusting data for some known vascular markers, the increase in the number of eye procedures with INT becomes more prevalent. This finding indicates that INT might not have a protective role in events requiring surgery in individuals with advanced diabetes.
Authors: William Duckworth; Carlos Abraira; Thomas Moritz; Domenic Reda; Nicholas Emanuele; Peter D Reaven; Franklin J Zieve; Jennifer Marks; Stephen N Davis; Rodney Hayward; Stuart R Warren; Steven Goldman; Madeline McCarren; Mary Ellen Vitek; William G Henderson; Grant D Huang Journal: N Engl J Med Date: 2008-12-17 Impact factor: 91.245
Authors: Nasrin Azad; Lily Agrawal; Nicholas V Emanuele; Ronald Klein; Gideon D Bahn; Peter Reaven Journal: Diabetologia Date: 2014-03-06 Impact factor: 10.122
Authors: Nasrin Azad; Gideon D Bahn; Nicholas V Emanuele; Lily Agrawal; Ling Ge; Dominic Reda; Ronald Klein; Peter D Reaven; Rodney Hayward Journal: Diabetes Care Date: 2016-03-22 Impact factor: 19.112