Several studies have demonstrated the link between elevated HbA1c plasma levels and CV risk. A multi-variate analysis of the United Kingdom Prospective Diabetes Study (UKPDS) study involving 2693 diabetic patients without known CV disease demonstrated that, for each increment of 1% in HbA1c at baseline, the CV risk increased independently by approximately 10% over a median follow-up of 8 years. Although hyperglycemia has been associated with CVD and epidemiologic evidence links lower blood glucose levels to a decrease in CV events, aggressive blood glucose control in type 2 diabetes within randomized trials has not been shown to significantly reduce macrovascular events,129 with the exception of patients presenting with acute MI105 or undergoing CABG.67 On the other hand, aggressive glucose-lowering therapy was associated with a significant reduction in microvascular complications.129 A putative explanation for the observed lack of benefit of glucose-lowering therapies on macrovascu-lar complications is that the achieved differences in HbA1c between control and intervention groups within the trials was insufficient. Optimal glycemic control, achieved with diet, exercise, and oral anti-diabetic agents or insulin, remains a major goal in treatment of type 2 diabetes.7
In type 1 diabetes, optimization of glycemic control is effective in preventing or delaying retinopathy, nephropathy, and neuropathy. Within the Diabetes Control and Complications Trial (DCCT), fewer CV events occurred in the intensive-treatment group than in the conventional-treatment group, but the small number of CV events in the relatively young cohort precluded a determination of whether the use of intensive diabetes therapy affected the risk of CVD. Long-term follow-up data on the DCCT/Epide-miology of Diabetes Interventions and Complications (EDIC) study cohort showed that intensive insulin therapy reduced significantly the risk of nonfatal MI, stroke, or CV death by 57% among 1182 patients monitored for 17 years.130 Therefore, inten
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...