Glycemic control and cardiovascular mortality

PURPOSE OF REVIEW: Diabetes mellitus is associated with several-fold increased risk of cardiovascular events, including death, yet whether treatment of hyperglycemia can reduce this risk remains controversial. RECENT FINDINGS: Epidemiologic associations between hyperglycemia and cardiovascular risk have been confirmed and extended to levels below those diagnostic of diabetes. Long-term follow-up of treatment early in diabetes suggests benefits may lag 10 years or more after initiation of treatment. Intensive glycemic treatment of high-risk persons with current methods may increase short-term mortality. SUMMARY: Further analyses of existing data to define high-risk and lower-risk subgroups of patients may allow revision of treatment guidelines. Future studies may begin early in diabetes, require long-term follow-up, and use improved methods of treatment.