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Chronic Health Problems Seem to Influence the Relationship of Blood Sugar Control and Cardiovascular Events in Patients With Type 2 Diabetes FREE

[+] Article and Author Information

The summary below is from the full report titled “Comorbidity Affects the Relationship Between Glycemic Control and Cardiovascular Outcomes in Diabetes. A Cohort Study.” It is in the 15 December 2009 issue of Annals of Internal Medicine (volume 151, pages 854-860). The authors are S. Greenfield, J. Billimek, F. Pellegrini, M. Franciosi, G. De Berardis, A. Nicolucci, and S.H. Kaplan.


Ann Intern Med. 2009;151(12):I-54. doi:10.7326/0003-4819-151-12-200912150-00002
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What is the problem and what is known about it so far?

Persons with type 2 diabetes are at high risk for cardiovascular events, such as heart attacks or stroke. Fortunately, this risk can be decreased with good medical care to control such risk factors as high blood pressure and high cholesterol. Although control of blood sugar improves the way patients feel and other diabetes complications, experts are not sure whether tight blood sugar control decreases the risk for cardiovascular events. Some studies show that it does and others do not. Experts think that the confusion may be because tight control benefits some patients but not others, depending on such factors as age and the presence of other health problems.

Why did the researchers do this particular study?

To see whether the relationship of tight control of blood sugar and cardiovascular events in patients with type 2 diabetes differed depending on the presence of other health problems.

Who was studied?

2613 patients with type 2 diabetes who were getting medical care in 205 physicians' offices in Italy.

How was the study done?

The researchers collected information on patients' control of blood sugar at the start of the study. They used hemoglobin A1c levels less than 6.5% and less than 7% to define tight control. The researchers collected information from patients on their history of heart disease, lung disease, heart failure, urinary tract disease, arthritis, foot problems, and digestive conditions and classified them as having low to moderate or high levels of other health problems. They then followed patients for about 5 years to see who developed new cardiovascular events.

What did the researchers find?

Tight blood sugar control was associated with a lower risk for new cardiovascular events in patients with low to moderate levels of health problems, but not in patients with high levels of health problems.

What were the limitations of the study?

This study cannot prove that lowering blood sugar will reduce cardiovascular events in persons with type 2 diabetes. Also, the researchers looked at only cardiovascular events and not at other benefits of blood sugar control, such as prevention of kidney and eye disease.

What are the implications of the study?

The presence of other health problems seems to influence the relationship of tight blood sugar control and cardiovascular events in persons with type 2 diabetes. The relationship between good control and fewer cardiovascular problems is evident in persons with low to moderate levels of health problems but not in sicker patients.

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