Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
Objectives Poorly controlled type 2 diabetes mellitus ( T2DM ) is a major international health problem .
Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes.
BACKGROUND The Veterans Affairs Diabetes Trial previously showed that intensive glucose lowering , as compared with st and ard 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 data bases 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 review s ( 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 st and ard-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 st and ard-therapy group ( hazard ratio , 0.83 ; 95 % confidence interval [ CI ] , 0.70 to 0.99 ; P=0.04 ) , with an absolute reduction in risk of 8.6 major cardiovascular events per 1000 person-years , but did not have reduced cardiovascular mortality ( hazard ratio , 0.88 ; 95 % CI , 0.64 to 1.20 ; P=0.42 ) . No reduction in total mortality was evident ( hazard ratio in the intensive-therapy group , 1.05 ; 95 % CI , 0.89 to 1.25 ; P=0.54 ; median follow-up , 11.8 years ) . CONCLUSIONS After nearly 10 years of follow-up , patients with type 2 diabetes who had been r and omly assigned to intensive glucose control for 5.6 years had 8.6 fewer major cardiovascular events per 1000 person-years than those assigned to st and ard therapy , but no improvement was seen in the rate of overall survival . ( Funded by the VA Cooperative Studies Program and others ; VADT Clinical Trials.gov number , NCT00032487 . )
Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
Objectives Poorly controlled type 2 diabetes mellitus ( T2DM ) is a major international health problem .