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J Diabetes Complications. 2011 Nov-Dec;25(6):355-61. doi: 10.1016/j.jdiacomp.2011.10.003. Epub 2011 Nov 4.

The duration of diabetes affects the response to intensive glucose control in type 2 subjects: the VA Diabetes Trial.

Collaborators (278)

Abraira C, Duckworth WC, Paul C, Arca D, Cason L, Zolotor RM, Williams L, Collier SL, Ahmed N, Boyd A, Reda D, Moritz T, Anderson R, Vitek ME, Paine T, Thottapurathu L, Luo P, Bukowski K, Motyka D, Barillas V, Brown R, Christine B, Anfinsen L, Biondic M, Havlicek R, Kubal J, McAuliffe M, McCarren M, Rachelle M, Rose L, Sacks J, Sindowski T, Thomas J, Zahora C, Sather MR, Warren S, Day J, Haroldson J, Davis SN, Nicholas E, Goldman S, Hayward R, Marks J, Moritz T, Reaven P, Reda D, Warren S, Zieve F, Wendell W, Haroldson J, Harper P, Henderson WG, Henry RR, Kirkman MS, McCarren M, Sacks J, Gavin J 3rd, Howard B, Karrison T, Pacold IV, Seigel D, Vinicor F, Massie B, Goldman S, Rapcsak S, Sethi G, Sharon M, Thai H, Zadina K, Christensen J, Morrison D, Spooner P, Westerband A, Materson B, Brinton E, Klein R, Colwell JA, Schaefer EJ, Gass CS, Ehrmann DA, Rue P, McNamara JR, Brophy M, Humphries D, Govan D, McDonnell L, Carlton L, Weng Y, Hayward RA, Krein S, Goldman S, Zadina K, Davis M, Glander K, Soule J, Caulder S, Pittman C, Alston O, Mayfield RK, Moffitt G, Sagel J, Sanacor F, Ganaway E, Marks J, Okur L, Jones L, Florez H, Pfeifer D, Samos L, Taylor AL, Zimering MB, Sama A, Rosenberg F, Garcia H, Ertel N, Pogach L, Shin JJ, Caldarella F, Carseli C, Shah M, Ginier P, Arakel G, Fu Y, Tayloe D, Allen JE, Fox E, Hensley PG, Emanuele N, Kahsen K, Linnerud P, Agrawal L, Azad N, Marcellie M, Cunningham GR, Nichols NM, Cordero E, Hijazi R, Roman F, Datta P, Touza MG, Lteif A, Moore KL, Lazar-Robinson C, Gupta S, Kirkman MS, Mendez M, Haider Z, Risley L, Karounos D, Barber L, Hibbard J, Anderson JW, Reynolds LR, Carlsen J, Collins RW, Ehtisham A, Kashyap ML, Matheus B, Rahbarnia T, Vo AN, Downey N, Fox L, Gonzales RM, Meyers CD, Tavintharan S, Nuttall FQ, Cupersmith L, Dardick K, Kollman L, Georgopoulos A, Niewoehner C, Davis SN, Harper P, Davis D, Devin J, Marney A, Passyn-Dunn J, Perkins J, Stafford J, Powers A, Balch L, Harris P, Anderson RJ, Dunning D, Ludwig S, Vogel M, DeSouza C, Ecklund R, Doran S, Korolchuk C, McElmeel M, Wagstaff S, Reaven P, Solie B, Matchette J, Meyer C, Vela S, Aslam N, Brinton E, Clark J, Domb A, McDonald L, Shurtz L, Rao RH, Beattie JN, Franko C, DeRubertis FR, Kelly D, Maser M, Paul J, Zieve F, Clark SJ, Grimsdale A, Fredrickson S, Levy J, Schroeder D, Iranmanesh A, Dunn B, Arsura D, Covesdy C, Hanna S, Iranmanesh A, Florow C, Remandaban F, Smith E, Henry RR, Keller M, Aroda V, Choe C, Edelman S, Gasper A, MaFong D, Mudaliar S, Oh D, Bandukwala R, Chang A, Chaudhary S, Chinnapongse S, Christiansen L, Chu N, Kim D, Lupo M, Manju C, Plodkowski R, Sathyaprakash R, Wilson J, Yu J, Macaraeg G, Townes S, DeFronzo R, Johnson L, Cusi K, Tripathy D, Bajaj M, Blodgett J, Kayshup S, Vasquez MH, Walz B, Weaver T, Benabe J, Mercado Z, Padilla B, Serrano-Rodriguez J, Rosado C, Mejias E, Tejera T, Geldrez C, Gonzalez-Melendez E, Natal M, Jimenez MR, Shah JH, Wendel WS, Scott L, Gurnsey LA, Kwiecinski FA, Boyden T, Goldschmid MG, Easton V.

Author information

1
Phoenix VA Health Care Center, Phoenix, AZ 85012, USA. william.duckworth@va.gov

Abstract

BACKGROUND:

The goal of the VA Diabetes Trial (VADT) was to determine the effect of intensive glucose control on macrovascular events in subjects with difficult-to-control diabetes. No significant benefit was found. This report examines predictors of the effect of intensive therapy on the primary outcome in this population.

METHODS:

This trial included 1791 subjects. Baseline cardiovascular risk factors were collected by interview and the VA record. The analyses were done by intention to treat.

FINDINGS:

Univariate analysis at baseline of predictors of a primary cardiovascular (CV) event included a prior CV event, age, insulin use at baseline, and duration of diagnosed diabetes (all P < .0001). Multivariable modeling revealed a U-shaped relationship between duration of diabetes and treatment. Modeled estimates for the hazard ratios (HRs) for treatment show that subjects with a short duration (3 years or less) of diagnosed diabetes have a nonsignificant increase in risk (HR > 1.0) after which the HR is below 1.0. From 7 to 15 years' duration at entry, subjects have HRs favoring intensive treatment. Thereafter the HR approaches 1.0 and over-21-years' duration approaches 2.0. Duration over 21 years resulted in a HR of 1.977 (CI 1.77-3.320, P < .01). Baseline c-peptide levels progressively declined up to 15 years and were stable subsequently.

INTERPRETATION:

In difficult-to-control older subjects with type 2 DM, duration of diabetes altered the response to intensive glucose control. Intensive therapy may reduce CV events in subjects with a duration of 15 years or less and may increase risks in those with longer duration.

PMID:
22055259
DOI:
10.1016/j.jdiacomp.2011.10.003
[Indexed for MEDLINE]

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