No cardiovascular benefit with tight control in DM2 with high comorbidity

January 01, 0001

No cardiovascular benefit with tight control in DM2 with high comorbidity

These Italian and US investigators determined whether attaining hemoglobin A1c (HbA1c) targets of 6.5% or less or 7.0% or less for glycemic control at baseline provides differential benefits for patients with high versus low-to-moderate levels of comorbidity. They report results of a 5-year prospective cohort study 2613 patients. Patients were categorized into high and low-to-moderate comorbidity subgroups by using the Total Illness Burden Index (TIBI), a validated patient-reported measure of comorbidity.

They found: “Attaining an HbA1c level of 6.5% or less at baseline was associated with lower 5-year incidence of cardiovascular events in the low-to-moderate comorbidity subgroup (adjusted HR, 0.60) but not in the high comorbidity subgroup (adjusted HR, 0.92). Similarly, attaining a baseline HbA1c level of 7.0% predicted fewer cardiovascular events in the low-to-moderate comorbidity subgroup (adjusted HR, 0.61) but not in the high comorbidity subgroup (adjusted HR, 0.88).”

The authors concluded: “Patients with the high levels of comorbidity common in type 2 diabetes may receive diminished cardiovascular benefit from intensive blood glucose control. Comorbidity should be considered when tailoring glucose-lowering therapy in patients with type 2 diabetes.”

For patients with high comorbidity the risk of hypoglycemia and lack of expected cardiovascular benefit makes tight glucose control inadvisable.

For the full abstract, click here.

Annals of Internal Medicine 151:854-860, 15 December 2009 © 2009 to the American College of Physicians
Comorbidity Affects the Relationship Between Glycemic Control and Cardiovascular Outcomes in Diabetes-A Cohort Study. Sheldon Greenfield, John Billimek, Fabio Pellegrini, et al. Correspondence to: Dr. Nicolucci: [email protected]

Category: T. Endocrine/Metabolic/Nutritional, K. Circulatory. Keywords: diabetes mellitus, DM2, comorbidity, glycemic control, glycohemoglobin, HbA1c, cardiovascular events, prospective cohort study
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 12 January 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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