Intensive Glucose Control in Patients with Type 2 Diabetes — 15-Year Follow-up

This 15-year follow up study of the Veterans Affairs Diabetes Trial (VADT) evaluated the long-term effects of intensive glucose control (targeting a glycated hemoglobin level of 6.9%) versus standard therapy in 1791 military veterans with type 2 diabetes. Over a median follow up of 13.6 years, intensive therapy did not significantly reduce the risk of major cardiovascular events (hazard ratio, 0.91; 95% CI, 0.78–1.06) or mortality (hazard ratio, 1.02; 95% CI, 0.88–1.18). However, during the 10year period when glycated hemoglobin levels differed between groups, intensive therapy reduced cardiovascular events by 17% (hazard ratio, 0.83; 95% CI, 0.70–0.99). No legacy effect was observed after glycemic equalization. The findings suggest that sustained glucose control is necessary to maintain cardiovascular benefits, but intensive management did not improve long term survival or quality of life in this high risk cohort.

This 15-year follow up study of the Veterans Affairs Diabetes Trial (VADT) evaluated the long-term effects of intensive glucose control (targeting a glycated hemoglobin level of 6.9%) versus standard therapy in 1791 military veterans with type 2 diabetes. Over a median follow up of 13.6 years, intensive therapy did not significantly reduce the risk of major cardiovascular events (hazard ratio, 0.91; 95% CI, 0.78–1.06) or mortality (hazard ratio, 1.02; 95% CI, 0.88–1.18). However, during the 10year period when glycated hemoglobin levels differed between groups, intensive therapy reduced cardiovascular events by 17% (hazard ratio, 0.83; 95% CI, 0.70–0.99). No legacy effect was observed after glycemic equalization. The findings suggest that sustained glucose control is necessary to maintain cardiovascular benefits, but intensive management did not improve long term survival or quality of life in this high risk cohort.