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 Lund and Vaag
- Jay S. Skyler, MD, MACP
- University of Miami, Miami, Florida.
- Corresponding author: Jay S. Skyler, jskyler{at}miami.edu.
We thank Lund and Vaag (1) for their interest in the statement on intensive glycemic control and the prevention of cardiovascular events written by the American Diabetes Association (ADA), the American College of Cardiology Foundation (ACCF), and the American Heart Association (AHA) (2). The consensus algorithm on management of type 2 diabetes referenced in their letter represents the expert opinion of its authors alone (3) and was not written in response to the cardiovascular disease trials; therefore, our response only deals with the ADA/ACCF/AHA statement (2).
The ADA has suggested an A1C treatment goal of <7% for most patients with diabetes since 1994. At that time, it was based on the Diabetes Control and Complications Trial (DCCT) findings but was later supplemented by the UK Prospective Diabetes Study (UKPDS) and Kumamoto findings, all of which focused on microvascular outcomes. The ADA has also stressed individualization of glycemic goals based on individual characteristics and preferences of patients. The AHA and ACCF have affirmed ADA recommendations in this area. The position statement (2) was an opportunity for the ADA, joined by representatives of the AHA and ACCF, to reevaluate its recommendations for glycemic control in light of the results of three studies: Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease—Preterax and Diamicron Modified Release Controlled Evaluation …
