Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials: A Position Statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association
Response to Skyler et al.
- Søren S. Lund, MD1 and
- Allan A. Vaag, MD, PHD, DMSC1,2
- 1Steno Diabetes Center, Gentofte, Denmark;
- 2Department of Endocrinology, University of Lund, Malmö, Sweden.
- Corresponding author: Søren Søgaard Lund, sqrl{at}steno.dk.
Recently, international cardiovascular disease (CVD) and diabetes associations have published type 2 diabetes treatment guidelines based on the UK Prospective Diabtes Study (UKPDS), the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, the Action in Diabetes and Vascular Disease—Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, and the Veterans Affairs Diabetes Trial (VADT) (1,2), among others, recommending an A1C target of <7.0% for most patients. The evidence supporting this recommendation is ranked as level A—the highest possible (with evidence from multiple randomized trials/meta-analyses) (1). However, to our knowledge, the Kumamoto study of 110 Japanese patients is the only long-term type 2 diabetes investigation of intensive versus conventional control with clinical events as primary outcomes that has adopted this recommendation (3).
The UKPDS, ACCORD, ADVANCE, and VADT (or …
