Aim The aim of this study was to address the controversy over the influence of intensive glucose control on the risk for cardiovascular events in patients with Type 2 diabetes.Methods FRENA is an ongoing registry of stable outpatients with symptomatic coronary artery disease, cerebrovascular disease or peripheral artery disease. We compared the incidence of subsequent ischaemic events (myocardial infarction, stroke or critical limb ischaemia) in patients with Type 2 diabetes and mean HbA1c levels < 7.0% (< 53 mmol/mol) vs. those with HbA1c levels > 7.0% (> 53 mmol/mol).Results Of 974 patients with Type 2 diabetes, 480 (49%) had mean HbA1c levels < 7% (< 53 mmol/mol). Over a mean follow-up of 14 months, 126 patients (13%) had subsequent ischaemic events: myocardial infarction (43), stroke (29) and critical limb ischaemia (64). The incidence of subsequent ischaemic events was significantly lower in patients with mean HbA1c levels < 7.0% (< 53 mmol/mol) than in those with HbA1c levels > 7.0% (> 53 mmol/mol) (8.6 vs. 14 per 100 patient-years; rate ratio 0.6; 95% CI 0.4-0.9). These differences persisted after adjusting for potential confounders. However, this better outcome was only found in patients presenting with coronary artery disease (rate ratio 0.4; 95% CI 0.2-0.8), not in those with cerebrovascular disease (rate ratio 0.9; 95% CI 0.4-2.0) or peripheral artery disease (rate ratio 0.8; 95% CI 0.5-1.3). Patients with mean HbA1c levels < 7.0% (< 53 mmol/mol) also had a lower mortality (rate ratio 0.6; 95% CI 0.3-0.99).Conclusions In secondary prevention, patients with diabetes and HbA1c levels < 7.0% (< 53 mmol/mol) had a lower incidence of subsequent ischaemic events and a lower mortality than those with HbA1c levels > 7.0% (> 53 mmol/mol). These differences appeared only in patients with coronary artery disease. © 2010 The Authors. Diabetic Medicine © 2010 Diabetes UK.
|Publication status||Published - 1 Jan 2011|
- Arterial disease
- Glucose control
- Ischaemic events
- Secondary prevention