A study by the VA center Clinical Management Research and the University of Michigan Medical School has revealed that diabetic patients whose blood sugar levels are kept under control have a reduced risk of suffering a heart attack, stroke, heart failure or amputation. Managing diabetes reduces the risk of adverse cardiovascular events by 17%.
The research population consisted of 1,800 veterans with type 2 diabetes and the study consisted of a 6 year blood sugar study that randomly assigned research participants to either “tight” blood sugar control, or regular care. Controlling diabetes by managing blood sugar levels seemed to have the most opposite health impact.
The researchers specified that a long-term average of about 8 on the measurement called A1C hemoglobin was enough to achieve most of the benefit, but that many patients can be safely lowered to around 7.
“Taken together with findings from other large studies, we see that controlling blood sugar in diabetes can indeed decrease cardiovascular risk, though we continue to see no effect on risk of dying during the same time period,” said lead study author Rodney Hayward, M.D., of the VA Ann Arbor Healthcare System and U-M. “This finding reinforces the importance of combining good blood sugar control with control of other cardiovascular risk factors for a combined effect.”
The study revealed that striving for even lower A1C levels in all people with diabetes may not increase cardiovascular benefit enough to be worth the effort, especially if patients receive newer drugs with unclear long-term safety, already take many other medications, or experience medication-related issues such as weight gain or frequent low blood sugar reactions.
“Once someone has his or her A1C around 8 percent, we need to individualize treatment to the patient, balancing his or her individual cardiovascular risk based on personal and family history, his or her age and life expectancy, smoking history and medication side effects,” said Hayward “If you want to determine what the best A1C number is for you, and when should take another medication to lower it, you should decide with your doctor.”
In patients with long term diabetes the researchers recommend analyzing the impact of medication, which may have potential side effects, and combining diet and exercise with a healthier life style in patients. M
In addition to Hayward, the study’s authors are Peter D. Reaven, M.D., Wyndy L. Wiitala, Ph.D., Gideon D. Bahn, Ph.D., Domenic J. Reda, Ph.D., Ling Ge, M.S., Madeline McCarren, Ph.D., William C. Duckworth, M.D., and Nicholas V. Emanuele, M.D. for the VADT Investigators.