Intensive glycaemic control does not seem to reduce all cause mortality in patients with type 2 diabetes .
OBJECTIVE To assess the effect of targeting intensive glycaemic control versus conventional glycaemic control on  all cause mortality and cardiovascular mortality , non-fatal myocardial infa rct ion , microvascular complications , and severe hypoglycaemia in patients with type 2 diabetes .
Cardiovascular events and correlates in the Veterans Affairs Diabetes Feasibility Trial. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes.
BACKGROUND The risks and benefits of intensive therapy in non-insulin-dependent diabetes mellitus ( NIDDM ) need to be defined . In preparation for a long-term trial , a feasibility study of 153 men in 5 medical centers compared st and ard vs intensive insulin therapy . OBJECTIVE To assess the rate of development of new cardiovascular events and their correlates . METHODS Patients with a mean + /- SD age of 60 + /- 6 years and diagnosis of NIDDM for 7.8 + /- 4.0 years were r and omly assigned to a st and ard ( 1 insulin injection every morning ) or to an intensive treatment arm ( stepped plan from 1 evening injection of insulin , alone or with glipizide , to multiple daily injections ) design ed to attain near-normal glycemia levels . A 2.07 % separation of glycosylated hemoglobin ( HbA1c ) was sustained for a mean follow-up of 27 months ( P < .001 ) . Predefined cardiovascular events were assessed by a committee unaware of treatment assignment . RESULTS Mild and moderate hypoglycemic events were more frequent in the intensive than in the st and ard treatment arm ( 16.5 vs 1.5 per patient per year , respectively ) . Mean insulin dose was 23 % lower in the st and ard treatment arm ( P < .001 ) . There were 61 new cardiovascular events in 24 patients ( 32 % ) in the intensive treatment arm and in 16 patients ( 20 % ) in the st and ard treatment arm ( P = .10 ) . There was no difference in total and cardiovascular mortality ( n = 5 and n = 3 in the intensive and st and ard treatment arms , respectively ) or in new events in patients with cardiovascular history ( n = 10 in each arm ) . In Cox regression analysis , the only significant correlate for new cardiovascular events was previous cardiovascular disease ( P = .04 ) . Entering in the analysis any baseline cardiovascular abnormality , the regression model indicated a lower HbA1c level prior to the event as the only correlate for new cardiovascular events ( P = .05 ) . CONCLUSION A long-term prospect i ve trial is needed to assess the risk-benefit ratio of intensive insulin therapy for NIDDM in patients who require it
Intensive glycaemic control does not seem to reduce all cause mortality in patients with type 2 diabetes .
OBJECTIVE To assess the effect of targeting intensive glycaemic control versus conventional glycaemic control on  all cause mortality and cardiovascular mortality , non-fatal myocardial infa rct ion , microvascular complications , and severe hypoglycaemia in patients with type 2 diabetes .