No Legacy Effect with Intensive Glucose Control

A longer period of follow up revealed that there was no evidence of a legacy effect or a mortality benefit with intensive glucose control, although participants with type 2 diabetes who had been randomly assigned to intensive glucose control for 5.6 years had a lower risk of cardiovascular events than those who received standard therapy during the extended period of lower glycated hemoglobin. The originally trial enrolled 1791 participants, in which 1391 were in the survey cohort. The separation of the glycated hemoglobin curves between the intensive-therapy group (892 participants) and the standard-therapy group (899 participants) averaged 1.5 percentage points, and this difference declined to 0.2 to 0.3 percentage points by 3 years after the trial ended. Over a period of 15 years of follow-up (active treatment plus post-trial observation), the risks of major cardiovascular events or death were not lower in the intensive-therapy group than in the standard-therapy group (hazard ratio 0.91 and 1.02, respectively). The risk of major cardiovascular disease outcomes was reduced, however, during the 7.1 years of separation of the glycated hemoglobin curves (hazard ratio, 0.83), but this benefit did not continue after equalization of the glycated hemoglobin levels (hazard ratio, 1.26). The findings are consistent with previous studies and suggest that long-term maintenance of a lower glycated hemoglobin level may be necessary to maintain the benefit. Source: https://www.nejm.org/