The Medical Letter on Drugs and Therapeutics
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1289
In Brief: Intensive Glucose Lowering in Type 2 Diabetes
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The goal for drug therapy of type 2 diabetes is achieving and maintaining a near-normal glycated hemoglobin (HbA1C) concentration without inducing hypoglycemia; the target has generally been an HbA1C of 6.5-7.0% or lower. Whether treating to this level prevents macrovascular (cardiovascular) events has been unclear. Now, 2 large randomized, double-blind trials in patients with long-standing diabetes and at high risk for cardiovascular disease have found no decrease in macrovascular events with intensive glucose control.

The ACCORD trial in about 10,000 patients found that patients intensively treated with anti-hyperglycemic drugs, including frequent use of thiazolidinediones, mostly rosiglitazone (Avandia), and insulin, with an HbA1C target of 6.0% (actual median HbA1C 6.4%) did not obtain a significant reduction in major cardiovascular events (the primary endpoint) over a period of 3.5 ... more      

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Title: In Brief: Intensive Glucose Lowering in Type 2 Diabetes
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