Does intense control of blood sugars result in more benefits in diabetics?

For many years, it has always been believed that tighter control of blood sugars is beneficial to avoid complications of diabetes. There are some physicians who rigidly manage their diabetic patients with very strict blood sugar control. There are other physicians who believe that intense control of blood sugars is not as important.

In the recent study published in the lancet, investigators combined results from 5 large trials to shed further light on the confusing question of whether intensive glycemic control reduces risk for cardiovascular outcomes. Data from United Kingdom Prospective Diabetes Study (UKPDS), the PROspective pioglitAzone Clinical Trial In macroVascular Events (PROactive), the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), the Veterans Affairs Diabetes Trial (VADT), and the Action to Control Cardiovascular Risk in Diabetes trial (ACCORD) were evaluated.

Follow-up of nearly 163,000 person-years revealed that intensive glucose-lowering treatment significantly decreased incidence of nonfatal myocardial infarction and episodes of chest pain from coronary disease. However, researchers observed no statistically significant effect for stroke or death rate. The mean reduction in glycated hemoglobin (A1c) was 0.9%. The study also found that low sugar (hypoglycemic) events were more common among the intensively treated patients, but the proportion in either group that experienced severe events was fairly low.
Also evident in these trials was that individuals who received intensive treatment had gained a mean of 2.5 kg more weight than those on standard treatment.

So what does all this mean for the diabetic patient?

The above studies indicate that tight control of blood sugars may provoke episodes of hypoglycemia and also be associated with weight gain. However, one should not be misled and relax their efforts to achieve tight glucose control. Tight sugar control has many other benefits that are not always evident. At the moment, the American Diabetes Association has concluded that there is no need for major changes in blood sugar control targets. The tight sugar control does offer some benefits to the heart. Further, the ADA also recommends that for maximal benefit all diabetics should also make an effort to control their blood pressure and high cholesterol.

Ray KK, Seshasai SR, Wijesuriya S, et al
Lancet. 2009; 373:1765-1772

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