June 12, 2019
Neda Laiteerapong, MD, MS, Associate Director of Clinical Outcomes for the Center for Chronic Disease Research and Policy, has published an editorial with Kasia Lipska, MD, MHS, in the New England Journal of Medicine concerning the lack of glycemic legacy effects in the Veterans Affairs Diabetes Trial (VADT). The VADT included 1791 military veterans who had received a diagnosis of type 2 diabetes a mean of 11.5 years earlier and who had been randomly assigned to intensive or standard glucose control for a median of 5.6 years. A major implication of the VADT follow-up study is that older patients with advanced diabetes should not expect long-term cardiovascular benefits from intensive glycemic control. Instead, interventions that clearly reduce cardiovascular risk — such as smoking cessation, blood-pressure control, statin therapy, use of antiplatelet agents, and the use of glucose-lowering agents with proven cardiovascular benefits in patients with established cardiovascular disease — should be prioritized.