The Veterans Affairs Diabetes Trial (VADT) began about 15 years ago. Initial reports published in 2009 showed no significant benefit of tighter blood sugar control among 1791 veterans when assessing their rates of cardiovascular events (heart attack, sudden death, and stroke, CVD) nor for other diabetes complications (eye, kidney and nerve disorders). The current study, also published in the New England Journal of Medicine, is a five-years-on follow-up to that original study.
The intense and standard care groups differed in the dosage of the two oral hypoglycemic agents administered, with the intense group getting twice the dosage of the standard group. The medications chosen depended on the patients BMI: all patients in the study received two oral drugs, but obese patients got one different oral agent as compared to the leaner group, with the second drug the same in both groups.
The current study s results did not differ from the earlier study: there was no significant benefit in terms of either CVD mortality nor overall mortality between the tighter-controlled blood sugars and the less controlled (the determination was based on glycated hemoglobin levels, HbA1C).
This study's authors chose not to determine outcomes for any events other than CVD; the current authors decision the group was led by Dr. Robert A. Hayward of the VA Medical Center in Ann Arbor, MI not to re-assess for the presence of the very-troubling microvascular complications of diabetes, was explained thusly: Patients with type 2 diabetes have a greatly increased risk of cardiovascular events. Although end-stage microvascular events (such as end-stage renal disease and blindness) represent important complications of diabetes, the morbidity and mortality related to cardiovascular events are an order of magnitude greater than that related to microvascular events.
ACSH s Dr. Gil Ross commented: I have long believed that the risks of over-treating diabetics blood sugar to attain tight control was more risky than beneficial, given the propensity for potentially-life-threatening hypoglycemia low blood sugar sufficiently low to cause cognitive impairment, even fainting as a result. This follow-up study seems to agree with a more relaxed approach. But note: there are data to support tighter control to prevent or impede the progression of the small-arterial disorders also characteristic of diabetes: kidney, retinal/vision, and neurological disease. The overall approach requires a knowledgeable physician and an informed patient. In any event, diabetes need devoted adherence to weight loss, exercise, no smoking, and careful control of lipids and blood pressure.
