Is Glucose Control Important for Prevention of Cardiovascular Disease in Diabetes?

Patients affected by diabetes show an increased risk of cardiovascular disease (CVD) and mortality that reduces their life expectancy by 5–15 years (depending on the age at diagnosis). An 18-year follow-up study from Finland demonstrated a similar impact of type 1 and type 2 diabetes on cardiovascular mortality, with an increased risk of 5.2 and4.9 times for type 1 and type 2 diabetes, respectively (1). In type 1 diabetes, followup results from a large randomized clinical trial suggest that the improvement of metabolic control, obtained through intensive insulin treatment, can prevent CVD in the long term. On the other hand, despite some encouraging results (2,3), the results of trials assessing the long-term cardiovascular effects of improving metabolic control in type 2 diabetes are controversial. Here, we will present the main points supporting and will illustrate the main counterpoints challenging the importance of glucose control for prevention of CVD in diabetic patients.