Reference : L'etude clinique du mois. Controle glycemique et morbimortalite cardio-vasculaire chez l...
Scientific journals : Article
Human health sciences : Endocrinology, metabolism & nutrition
http://hdl.handle.net/2268/4215
L'etude clinique du mois. Controle glycemique et morbimortalite cardio-vasculaire chez le patient diabetique de type 2. Resultats des etudes ACCORD, ADVANCE et VA-Diabetes.
French
[en] Blood glucose control and cardiovascular disease in patients with type 2 diabetes. Results of ACCORD, ADVANCE and VA-Diabetes Trials
Radermecker, Régis mailto [Centre Hospitalier Universitaire de Liège - CHU > > Diabétologie,nutrition, maladies métaboliques >]
Philips, Jean-Christophe mailto [Centre Hospitalier Universitaire de Liège - CHU > > Diabétologie,nutrition, maladies métaboliques >]
Jandrain, Bernard mailto [Centre Hospitalier Universitaire de Liège - CHU > > Diabétologie,nutrition, maladies métaboliques >]
Paquot, Nicolas mailto [Centre Hospitalier Universitaire de Liège - CHU > > Diabétologie,nutrition, maladies métaboliques >]
Scheen, André mailto [Université de Liège - ULg > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale >]
Jul-2008
Revue Médicale de Liège
63
7-8
511-8
Yes (verified by ORBi)
0370-629X
Belgium
[en] Aged ; Blood Glucose/drug effects ; Cardiovascular Diseases/etiology/mortality/prevention & control ; Diabetes Mellitus, Type 2/complications/drug therapy ; Female ; Hemoglobin A, Glycosylated/drug effects/metabolism ; Humans ; Male ; Middle Aged ; Randomized Controlled Trials as Topic ; Risk Factors
[en] Type 2 diabetes is associated with a high risk of complications, essentially macrovascular events. Surprisingly, the effect of improved glucose control on coronary and cerebrovascular complications in this population remains questionable. Furthermore, the target level of glycated haemoglobin (HbA1c) to minimise the risk of diabetic complications is controversial. We report the results of three recent randomised control trials (ACCORD, ADVANCE, Veterans Affairs Diabetes), which assessed the impact on cardiovascular events of intensive glucose-lowering therapy. None of these studies was able to demonstrate a significant reduction of cardiovascular events in the intensive group as compared to the standard group. On the contrary, in ACCORD, the study with the most ambitious goal (HbA1c < 6%), the overall and cardiovascular mortality was greater in the intensive group. In contrast, in the ADVANCE trial, the mortality and the incidence of cardiovascular events were not statistically different between the two treatment groups, whereas the risk of microangiopathic complications, especially nephropathy, was significantly decreased in the intensive group (HbA1c < or = 6.5%, with modified release gliclazide as main treatment). Finally, VA-Diabetes showed that the effect of better glucose control on cardiovascular complications disappeared with duration of the disease and that the risk of cardiovascular events increased in patients with severe hypoglycaemic episodes. In the three studies, the hypoglycaemic risk was indeed increased in the intensive group, which may contribute to reduce the positive impact of better glucose control on cardiovascular complications. The best way to protect type 2 diabetic patients against coronary and cerebrovascular disease is to target all cardiovascular risk factors.
Researchers ; Professionals ; Students
http://hdl.handle.net/2268/4215
http://www.rmlg.ulg.ac.be/index.php?page=resume?num_id=1781

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