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To the Editor: Recently, Drs. Zimmerman and Pantalone1 cited the Diabetes Control and Complications Trial (DCCT)2 and the United Kingdom Prospective Diabetes Study (UKPDS)3 as evidence that glycemic control lowers cardiac risk in type 2 diabetes. And in a related counterpoint article, Drs. Menon and Aggarwal4 also discussed the UKPDS.
These studies should not be cited in this context, since the DCCT is a study of type 1 and not type 2 diabetic patients, and the UKPDS was performed in an era when statins were not available. The UKPDS was launched in 1977 and completed in 1997, and statins were not available until 1987. Indeed, the UKPDS showed that the strongest risk factor for myocardial infarction was an elevated level of low-density lipoprotein cholesterol, followed by a low level of high-density lipoprotein cholesterol.5 It is therefore not surprising that in the initial UKPDS report the incidence of myocardial infarction was not increased in the group with a 0.9% higher hemoglobin A1c, but that in the 10-year follow-up, when statins were probably used by most patients, myocardial infarction was reduced by a significant 15% (P = .01).3,6 As would be expected in the more modern studies, ie, the Action to Control Cardiovascular Risk (ACCORD),7 the Action in Diabetes and Vascular Disease (ADVANCE),8 and the Veteran Affairs Diabetes Trial (VADT),9 cardiovascular events were not reduced with improved glycemic control.
While the UKPDS clearly demonstrated a decrease in microvascular disease due to improved glycemic control, it should not be used as evidence that improved glycemic control in type 2 diabetes decreases cardiac events.3,6
- Zimmerman RS, Pantalone KM. Diabetes management: more than just cardiovascular risk? Cleve Clin J Med 2014; 81:672–676.
- The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977–986.
- UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352:837–853.
- Menon V, Aggarwal B. Why are we doing cardiovascular outcome trials in type 2 diabetes? Cleve Clin J Med 2014; 81:665–671.
- Turner RC, Millns H, Neil HA, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ 1998; 316:823–828.
- Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359:1577–1589.
- Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358:2545–2559.
- ADVANCE Collaborative Group; Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358:2560–2572.
- Duckworth W, Abraira C, Moritz T, et al; VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360:129–139.
To the Editor: Recently, Drs. Zimmerman and Pantalone1 cited the Diabetes Control and Complications Trial (DCCT)2 and the United Kingdom Prospective Diabetes Study (UKPDS)3 as evidence that glycemic control lowers cardiac risk in type 2 diabetes. And in a related counterpoint article, Drs. Menon and Aggarwal4 also discussed the UKPDS.
These studies should not be cited in this context, since the DCCT is a study of type 1 and not type 2 diabetic patients, and the UKPDS was performed in an era when statins were not available. The UKPDS was launched in 1977 and completed in 1997, and statins were not available until 1987. Indeed, the UKPDS showed that the strongest risk factor for myocardial infarction was an elevated level of low-density lipoprotein cholesterol, followed by a low level of high-density lipoprotein cholesterol.5 It is therefore not surprising that in the initial UKPDS report the incidence of myocardial infarction was not increased in the group with a 0.9% higher hemoglobin A1c, but that in the 10-year follow-up, when statins were probably used by most patients, myocardial infarction was reduced by a significant 15% (P = .01).3,6 As would be expected in the more modern studies, ie, the Action to Control Cardiovascular Risk (ACCORD),7 the Action in Diabetes and Vascular Disease (ADVANCE),8 and the Veteran Affairs Diabetes Trial (VADT),9 cardiovascular events were not reduced with improved glycemic control.
While the UKPDS clearly demonstrated a decrease in microvascular disease due to improved glycemic control, it should not be used as evidence that improved glycemic control in type 2 diabetes decreases cardiac events.3,6
To the Editor: Recently, Drs. Zimmerman and Pantalone1 cited the Diabetes Control and Complications Trial (DCCT)2 and the United Kingdom Prospective Diabetes Study (UKPDS)3 as evidence that glycemic control lowers cardiac risk in type 2 diabetes. And in a related counterpoint article, Drs. Menon and Aggarwal4 also discussed the UKPDS.
These studies should not be cited in this context, since the DCCT is a study of type 1 and not type 2 diabetic patients, and the UKPDS was performed in an era when statins were not available. The UKPDS was launched in 1977 and completed in 1997, and statins were not available until 1987. Indeed, the UKPDS showed that the strongest risk factor for myocardial infarction was an elevated level of low-density lipoprotein cholesterol, followed by a low level of high-density lipoprotein cholesterol.5 It is therefore not surprising that in the initial UKPDS report the incidence of myocardial infarction was not increased in the group with a 0.9% higher hemoglobin A1c, but that in the 10-year follow-up, when statins were probably used by most patients, myocardial infarction was reduced by a significant 15% (P = .01).3,6 As would be expected in the more modern studies, ie, the Action to Control Cardiovascular Risk (ACCORD),7 the Action in Diabetes and Vascular Disease (ADVANCE),8 and the Veteran Affairs Diabetes Trial (VADT),9 cardiovascular events were not reduced with improved glycemic control.
While the UKPDS clearly demonstrated a decrease in microvascular disease due to improved glycemic control, it should not be used as evidence that improved glycemic control in type 2 diabetes decreases cardiac events.3,6
- Zimmerman RS, Pantalone KM. Diabetes management: more than just cardiovascular risk? Cleve Clin J Med 2014; 81:672–676.
- The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977–986.
- UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352:837–853.
- Menon V, Aggarwal B. Why are we doing cardiovascular outcome trials in type 2 diabetes? Cleve Clin J Med 2014; 81:665–671.
- Turner RC, Millns H, Neil HA, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ 1998; 316:823–828.
- Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359:1577–1589.
- Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358:2545–2559.
- ADVANCE Collaborative Group; Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358:2560–2572.
- Duckworth W, Abraira C, Moritz T, et al; VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360:129–139.
- Zimmerman RS, Pantalone KM. Diabetes management: more than just cardiovascular risk? Cleve Clin J Med 2014; 81:672–676.
- The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977–986.
- UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352:837–853.
- Menon V, Aggarwal B. Why are we doing cardiovascular outcome trials in type 2 diabetes? Cleve Clin J Med 2014; 81:665–671.
- Turner RC, Millns H, Neil HA, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ 1998; 316:823–828.
- Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359:1577–1589.
- Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358:2545–2559.
- ADVANCE Collaborative Group; Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358:2560–2572.
- Duckworth W, Abraira C, Moritz T, et al; VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360:129–139.