Intensive control of type 2 diabetes fails to prevent cardiovascular disease, again

Intensive control of blood sugar may not the best way to prevent cardiovascular disease in people with type 2 diabetes, say researchers, after a third large trial failed to find any benefit. Doctors should focus on blood pressure, serum lipids, weight, smoking, and other known cardiovascular risk factors instead⇑.

The new trial compared more or less intensive treatment in 1791 older men with longstanding and poorly controlled type 2 diabetes. Both groups began with two oral agents and moved on to insulin if needed. Initial drug doses were higher and insulin use more liberal for patients in the intensive treatment group.

The risk of cardiovascular events was comparable in both groups during a median follow-up of 5.6 years (hazard ratio 0.88, 95% CI 0.74 to 1.05), despite a clear difference in glycaemic control (glycated haemoglobin 6.9% v 8.4%). Men in the intensive treatment group gained more weight and reported more hypoglycaemia than controls.

The average patient in this trial was 60 years old, with a body mass index of …