Is glucose normalization an evidence-based treatment for patients with type 2 diabetes mellitus?

Author(s): Ryden L, Malmberg K, Mellbin L

Affiliation(s): L Ryden is Professor Emeritus in Cardiology, K Malmberg is Professor of Cardiology and L Mellbin is Senior Resident at the Cardiology Unit of the Department of Medicine, Karolinska Institutet, Stockholm, Sweden.

Publication date & source: 2008-10-28, Nat Clin Pract Endocrinol Metab., [Epub ahead of print]

The incidence of adverse events related to type 2 diabetes mellitus (T2DM) is correlated to the degree of hyperglycemia. This relationship suggests that strict glycemic control might reduce the risk of adverse outcomes. In this commentary, we discuss a randomized, controlled trial that assessed the effect of an intensive therapy targeting a normal HbA(1c) level as compared with standard therapy in patients with T2DM at high risk of cardiovascular events. As compared with the standard therapy group, major cardiovascular events occurred in fewer patients in the intensive therapy group, but the total mortality was higher, which lead to the premature termination of the study after 3.5 years. Further clinical trials are needed to establish whether glucose normalization is beneficial in patients with T2DM and whether this is true for all or only subgroups of these patients. At present, patients with T2DM should be managed by a multifactorial strategy in which glucose lowering, targeted at currently recommended levels, is one of several components.