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The Journal of Nurse Practitioners
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Dixie Harms, DNP - Figure 8
Impact of Intensive Therapy for Diabetes: Summary of Major Clinical Trials
Figure 8 reports a summary of important endpoint results from five of the major trials of intensive therapy for T2DM[6][7][8][9][10][11][12] (or type 1 diabetes in the case of the EDIC trial[9]). As seen in the Figure, all these trials resulted in a decrease in microvascular disease (angina, dyspnea). However the results for treating cardiovascular disease (CVD) were neutral except in the UKPDS[6] and DCCT/EDIC trials,[8][9] which reported possible benefit. The effect of intensive glucose-lowering therapy for diabetes on risk of mortality was also neutral except in the large UKPDS trial, which found a decrease in mortality on long-term follow-up,[7] or the ACCORD trial, which found a small increase in mortality with intensive therapy.[10] Harms D. J Nurse Pract. 2014; 00:00 – 00.
Trial acronyms:
ACCORD – Action to Control Cardiovascular Risk in Diabetes
ADVANCE – Action in Diabetes and Vascular Disease: PreterAx and DiamicroN MR Controlled Evaluation
DCCT/EDIC – Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications
UKPDS – United Kingdom Prospective Diabetes Study
VADT – Veterans Affairs Diabetes Trial
References
UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854-865.
Holman RR, Paul SK, Bethel MA, et al. 10-Year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577-1589.
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.
Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;22:2643-2653.
The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545-2559.
ADVANCE Collaborative Group. 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.