Follow-up of Glycemic Control and Cardiovascular Outcomes in Type 2 Diabetes

作者：Rodney A. Hayward, Peter D. Reaven, Wyndy L. Wiitala, Gideon Bahn, Domenic J. Reda, Ling Ge, Madeline McCarren, William C. Duckworth, Nicholas Emanuele · 发表于：New England Journal of Medicine · 年份：2015 · DOI：10.1056/nejmoa1414266 · 被引用次数：669 · 研究领域：Hyperglycemia and glycemic control in critically ill and hospitalized patients、Diabetes Treatment and Management、Diabetes, Cardiovascular Risks, and Lipoproteins

BACKGROUND: The Veterans Affairs Diabetes Trial previously showed that intensive glucose lowering, as compared with standard therapy, did not significantly reduce the rate of major cardiovascular events among 1791 military veterans (median follow-up, 5.6 years). We report the extended follow-up of the study participants. METHODS: After the conclusion of the clinical trial, we followed participants, using central databases to identify procedures, hospitalizations, and deaths (complete cohort, with follow-up data for 92.4% of participants). Most participants agreed to additional data collection by means of annual surveys and periodic chart reviews (survey cohort, with 77.7% follow-up). The primary outcome was the time to the first major cardiovascular event (heart attack, stroke, new or worsening congestive heart failure, amputation for ischemic gangrene, or cardiovascular-related death). Secondary outcomes were cardiovascular mortality and all-cause mortality. RESULTS: The difference in glycated hemoglobin levels between the intensive-therapy group and the standard-therapy group averaged 1.5 percentage points during the trial (median level, 6.9% vs. 8.4%) and declined to 0.2 to 0.3 percentage points by 3 years after the trial ended. Over a median follow-up of 9.8 years, the intensive-therapy group had a significantly lower risk of the primary outcome than did the standard-therapy group (hazard ratio, 0.83; 95% confidence interval [CI], 0.70 to 0.99; P=0.04), with an absolute r...