PMID- 21608354
OWN - NLM
STAT- MEDLINE
DCOM- 20110712
LR  - 20221207
IS  - 0970-258X (Print)
IS  - 0970-258X (Linking)
VI  - 24
IP  - 1
DP  - 2011 Jan-Feb
TI  - Intensive glycaemic control in type 2 diabetes mellitus: does it improve 
      cardiovascular outcomes?
PG  - 21-7
AB  - With growing urbanization and economic development, there is a rapid increase in 
      the incidence of type 2 diabetes mellitus (T2DM) in India. T2DM is associated 
      with 2-4 times higher risk for cardiovascular disease (CVD), including coronary 
      artery disease, stroke and peripheral vascular disease. Several studies have 
      shown the benefit of intensive glycaemic control in reducing the frequency of 
      diabetic microvascular complications such as retinopathy and nephropathy. Results 
      of long term follow up of patients with diabetes, who were enrolled in earlier 
      trials, have shown that initial intensive glycaemic control led to a reduction in 
      CVD outcomes when compared with standard therapy. However, it is unclear if 
      intensive glycaemic control, aiming to reduce haemoglobin A1c to levels even 
      lower than the current goal of <7%, will similarly lead to reduction in the rates 
      of CVD. Recently, the results of 3 large, randomized controlled trials have been 
      published, which suggest that in established T2DM with previous CVD or high risk 
      of CVD, the benefits of intensive glycaemic control when compared with 
      conventional good control, are minimal with regards to reduction of 
      cardiovascular outcomes. Intensive therapy increases the risk of side-effects 
      such as severe hypoglycaemia and weight gain. The implementation of such a 
      therapy, with rigorous attention to frequent monitoring of blood glucose and 
      visits to the physician, is not likely to be possible on a large scale, 
      especially in a developing country such as India. The aim of management of 
      patients with established T2DM should be to achieve the goal of good glycaemic 
      control (haemoglobin A1c<7%), with avoidance of hypoglycaemia. It is equally, if 
      not more important, to control other risk factors of CVD by paying greater 
      attention to lifestyle measures (weight loss if overweight or obese, regular 
      exercise, cessation of smoking), rigorous control of blood pressure (<130/80 
      mmHg) and low density lipoprotein (LDL) cholesterol (<100 mg/dl or <70 mg/dl if 
      already diagnosed with CVD) and the prophylactic use of low dose aspirin as per 
      current recommendations. A multifactorial approach targeting multiple 
      cardiovascular risk factors is likely to be most effective in reducing CVD 
      outcomes in T2DM.
FAU - Reddy, Sagili Vijaya Bhaskar
AU  - Reddy SV
AD  - Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical 
      Sciences, Rae Bareli Road, Lucknow 226014, Uttar Pradesh, India.
FAU - Bhatia, Eesh
AU  - Bhatia E
LA  - eng
PT  - Journal Article
PT  - Review
PL  - India
TA  - Natl Med J India
JT  - The National medical journal of India
JID - 8809315
RN  - 0 (Blood Glucose)
RN  - 0 (Cholesterol, LDL)
RN  - 0 (Glycated Hemoglobin A)
SB  - IM
MH  - Blood Glucose/*metabolism
MH  - Blood Pressure
MH  - Cardiovascular Diseases/epidemiology/*etiology/prevention & control
MH  - Cholesterol, LDL/blood
MH  - Diabetes Mellitus, Type 2/*blood/complications/*drug therapy
MH  - Glycated Hemoglobin/*metabolism
MH  - Humans
MH  - Life Style
EDAT- 2011/05/26 06:00
MHDA- 2011/07/13 06:00
CRDT- 2011/05/26 06:00
PHST- 2011/05/26 06:00 [entrez]
PHST- 2011/05/26 06:00 [pubmed]
PHST- 2011/07/13 06:00 [medline]
PST - ppublish
SO  - Natl Med J India. 2011 Jan-Feb;24(1):21-7.