Lack of Glycemic Legacy Effects in the Veterans Affairs Diabetes Trial

This editorial discusses the findings from the 15year follow up of the Veterans Affairs Diabetes Trial (VADT), which investigated whether intensive glycemic control in patients with advanced type 2 diabetes leads to long term cardiovascular benefits ("glycemic legacy effects"). Unlike earlier studies such as the DCCT and UKPDS, the VADT found no significant reduction in cardiovascular events or mortality with intensive control after glycated hemoglobin levels equalized between groups. The authors suggest that the absence of legacy effects in VADT may be due to preexisting vascular damage in advanced diabetes or the contemporary use of comprehensive cardiovascular risk management. They emphasize prioritizing proven interventions (e.g., statins, blood-pressure control) over intensive glycemic targets for older patients with advanced diabetes, while acknowledging potential legacy benefits for younger patients.

This editorial discusses the findings from the 15year follow up of the Veterans Affairs Diabetes Trial (VADT), which investigated whether intensive glycemic control in patients with advanced type 2 diabetes leads to long term cardiovascular benefits ("glycemic legacy effects"). Unlike earlier studies such as the DCCT and UKPDS, the VADT found no significant reduction in cardiovascular events or mortality with intensive control after glycated hemoglobin levels equalized between groups. The authors suggest that the absence of legacy effects in VADT may be due to preexisting vascular damage in advanced diabetes or the contemporary use of comprehensive cardiovascular risk management. They emphasize prioritizing proven interventions (e.g., statins, blood-pressure control) over intensive glycemic targets for older patients with advanced diabetes, while acknowledging potential legacy benefits for younger patients.