Glucose control and cardiovascular complications: the VA Diabetes Trial.

T he Veterans Affairs Cooperative Studies Program (VACSP) has just initiated a trial of the effect of intensive glucose control on cardiovascular complications in patients with type 2 diabetes. The name of the trial is “VACSP #465, Glycemic Control and Complications in Diabetes Mellitus type 2” (V.A. Diabetes Trial [VADT]). The trial is expected to generate discussion in the diabetes community because the central role of glucose control in preventing or delaying long-term complications is generally accepted. The data on macrovascular disease are not yet conclusive. The VADT is directed at type 2 diabetic patients with established uncontrolled diabetes. This is the population most frequently encountered by the practicing physician. Cardiovascular (CV) complications are the major causes of morbidity and mortality in patients with type 2 diabetes (1). Efforts to reduce glucose levels in these patients must be balanced between risks and benefits. Consideration of intensive therapy must include effects of glucose control on microvascular complications, macrovascular complications, complications of therapy, and socioeconomic issues, including patient quality of life, compliance with therapy, and distribution of available funds for care of patients with diabetes.