New tailored goals for type 2 diabetes patients?

In treating patients with type 2 diabetes, our goal had been to reduce the HBA1C to the near normal range(<6%).>

hypoglycemia was in 20% treatement vs 8.8% control

There were 29 cardiovascular deaths in the standard-treatment vs. 36 in the intensive-treatment group.

with sudden death in 4 vs. 11 patients, respectively, accounting for all of the excess mortality.

Predictors of sudden death were a prior macrovascular event, BMI, A1C at baseline, weight gained during the study, and low HDL cholesterol.

Recent severe hypoglycemia was a predictor of cardiovascular death and of the primary outcome and, in the standard-treatment group, of all-cause mortality.

From the VADT trial, it appears that there can be harm from intense glucose control. They looked at the benefit in relationship to duration of type 2 diabetes.

1. "Duration was a significant predictor of the primary end point and showed a highly significant interaction with the treatment effect in the intensive-treatment group, suggesting that intensive treatment might be protective during the first decade of diabetes but that late intensive treatment in the fashion used in the VADT might be harmful. "
2. "The CAC score was independent of standard cardiovascular risk factors and was an even stronger risk factor than having a prior event. Furthermore, Reaven showed evidence that the effect of the treatment assignment was modified by the baseline CAC score: the participants with a baseline CAC score <100>100. "

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