The association between metabolic control and prevalent macrovascular disease in Type 2 diabetes: The VA Cooperative Study in diabetes

The problem: Macrovascular disease (MVD), especially corollary heart disease, is the most common cause of mortality in Type 2 diabetes. We assessed the association between demographic and clinical variables (particularly HbAlc) and prevalent MVD at time of enrollment into the VA Diabetes Trial (VADT), a 7-year randomized trial to determine whether intensive glycemic control will reduce risk of MVD events in older participants with established Type 2 diabetes. Research design and methods: We compared the demographic, treatment, and clinical characteristics of participants with and without known MVD, then assessed the interaction of multiple variables with HbAlc. Logistic regression models evaluated the association between HbAlc quartiles and prevalence of MVD, adjusting for potentially confounding variables. Results: Several variables were associated with prevalent MVD (age, duration of diabetes, insulin use but not daily dosage, smoking history, hypertension, BMI, Caucasian race, non-Hispanic ethnicity, lower HDL cholesterol, higher triglycerides, lower LDL cholesterol, and statin use). In univariate analysis, there was no association of HbAlc with MVD (mean: 9.4 +/- 1.46% in those with MVD, 9.5 +/- 1.58% in those without). Multivariate analyses found little confounding of the lack of association of HbAlc with MVD. Only adjustment for age produced a slight increase in the odds ratio, but only for the highest quartite of HbAlc. Conclusions: In this cross-sectional analysis, MVD was associated with a number of clinical and demographic variables but not with HbAlc. Determining whether intensive lowering of HbAlc will reduce the prospective rate of MVD events in this population of older participants with established Type 2 diabetes is the primary objective of our trial. Published by Elsevier Inc.