The ACCORD, ADVANCE, and VADT
suggested no significant reduction in
CVD outcomes with intensive glycemic
control in participants followed for
3.525.6 years who had more advanced
type 2 diabetes than UKPDS participants.
All three trials were conducted
in participants with more long-standing
diabetes (mean duration 8–11 years)
and either known CVD or multiple cardiovascular
risk factors. The target A1C
among intensive control subjects was
,6% in ACCORD, ,6.5% in ADVANCE,
and a 1.5% reduction in A1C compared
with control subjects in VADT. Details of
these studies are reviewed extensively
in the ADA position statement “Intensive
Glycemic Control and the Prevention
of Cardiovascular Events: Implications
of the ACCORD, ADVANCE, and VA
Diabetes Trials: A Position Statement
of the American Diabetes Association
and a Scientific Statement of the
American College of Cardiology Foundation
and the American Heart
Association” (42).