Beneficial and Detrimental Effects of Glycemic Control on Cardiovascular Disease in Type 2 Diabetes

• Published in: Current cardiology reports 2013-02, Vol.15 (2), p.332, Article 332
• Main Authors: Taub, Pam R., Higginbotham, Erin, Henry, Robert R.
• Format: Article
• Language: English
• Subjects: Blood Glucose - metabolism; Cardiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Diabetes and Cardiovascular Disease (S Malik; Diabetes Mellitus, Type 2 - drug therapy; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Medicine; Medicine & Public Health; Section Editor; Topical Collection on Diabetes and Cardiovascular Disease
• ISSN: 1523-3782; 1534-3170
• DOI: 10.1007/s11886-012-0332-4

Epidemiological data demonstrates that improved regulation of blood glucose correlates with better cardiovascular (CV) outcomes. Conversely, some interventional studies have demonstrated that tight glycemic control has no benefit or can even result in worse CV outcomes. These conclusions parallel the paradox that glycemic control has proven beneficial for microvascular outcomes, while few studies have demonstrated significant macrovascular benefits. This imprecise understanding conveys the need to better comprehend the mechanisms of glycemic control and its impact on CV disease. Such variations in data also require a more comprehensive approach to diabetes and CV disease in which multiple biomarkers such as low density lipoprotein (LDL), low adiponectin, elevated C-reactive protein (CRP) and well established clinical parameters such as high blood pressure, weight, and functional status are incorporated into clinical decision making. Reliance on one parameter in isolation such as glycemic control and one biomarker such as HbA1C does not provide an accurate assessment of CV outcomes.