R1 강민혜 / prof. 전숙

Introduction Patients with type 2 diabetes have a greatly increased risk of cardiovascular events. The morbidity and mortality related to cardiovascular events are an order of magnitude greater than that related to microvascular events. Most observational studies have shown an association between glucose control and cardiovascular disease. ACCORDADVANCEVADTUKPDS Median age: 62yrs old HbA1c ≤6.0% vs 7~7.9 Median 5.6yrs Increased mortality Median age: 65yrs old, 10yrs DM Hx. HbA1c ≤6.5% vs 7~7.9 Median 5yrs microvascular event ↓ Median age: 60.5yrs old 11.5yrs DM Hx. HbA1c difference: 1.5% Median 5.6yrs No benefit to CVD Median age: 53yrs old Newly diagnosed DM Median 10yrs

Introduction We report cardiovascular outcomes after an extended follow-up period of the VADT VADT ; a multisite, randomized, controlled trial of intensive versus standard glucose control in U.S. military veterans with type 2 diabetes, in which patients were followed for up to 7.5 years The current prespecified analysis includes approximately 5 additional years of observational follow-up of the study cohort.

Methods  Original study design 1791 military veterans with type 2 DM a multisite, randomized, controlled trial intensive or standard glucose control The interventional component of the study ended on May 29, 2008 (median follow-up, 5.6 years). → national data registry, yearly survey, chart reviews

Methods  Data sources Four national data registries - the central VA medical information files, - the Centers for Medicare and Medicaid Services (CMS) Medicare claims files - the VA death files -the National Death Index (NDI) Annual self-administered survey: major events, care center ≤65yrs, an event outside the VA system → hospital record Median 9.8years (up to 11.8yrs)

Methods  Primary and Secondary outcomes Primary outcome ; the time to the first major cardiovascular event (a composite of heart attack, stroke, new or worsening congestive heart failure, death from cardiovascular causes, or amputation for ischemic gangrene) Secondary outcome ; Cardiovascular mortality and total mortality. (-) selected cardiac procedure new pph vascular disease (2009)

Results -Characteristics of the Patients Complete cohort 92.4% Survey cohort 77.7%

Results -Characteristics of the Patients

2009’ VADT 2015’

Results - Primary Outcome and Secondary Outcomes -17%

Conclusion After nearly 10 years of follow-up, patients with type 2 diabetes who had been randomly assigned to intensive glucose control for 5.6 years had 8.6 fewer major cardiovascular events per 1000 person- years than those assigned to standard therapy, but no improvement was seen in the rate of overall survival.