Blood Glucose and Cardiovascular Disease

Patients with diabetes are at particular risk of developing cardiovascular disease. It is well established that hyperglycaemia is directly and independently associated with an increase in the incidence of cardiovascular-related morbidity and mortality rates. It has also been proven that reducing blood glucose levels is effective in preventing microangiopathy - and this in both type 1 and type 2 diabetes. The most influential studies to this effect are the DCCT and the UKPDS. In both these trials, however, the long-term benefit of blood glucose reduction was not that impressively visible until the non-blinded follow-up phases. According to the ACCORD study's data, however, too drastic a reduction in blood glucose and hypoglycaemia may pose potential dangers to patients, especially those with a history of heart disease. In view of this, and as shown in the ADVANCE study as well as the VADT, it is safe to say that it is not a sudden drop in HbA(1c) to levels of less than 7 % or even 6.5 % that will prevent micro- or even macrovascular complications, but a gradual reduction in blood glucose over time, combined with the avoidance of complications and of weight gain. This is particularly true for those with previous heart failure or those with an already very high HbA(1c) at the outset of therapy.