Cardiovascular autonomic neuropathy (CAN) risk may be reduced among type 2 diabetes patients undergoing intensive glycemic therapy, according to a study to be published in the January issue of Diabetes Care. Investigators examined the effect of intensively treating traditional risk factors for CAN (hyperglycemia, hypertension, and dyslipidemia) among 7,275 individuals with type 2 diabetes and high cardiovascular risk participating in the Action to Control Cardiovascular Risk in Diabetes trial. Compared with standard intervention, intensive glucose treatment reduced CAN risk (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.75 to 0.94; P = 0.003), an effect driven by individuals without cardiovascular disease (CVD) at baseline (OR, 0.73; 95% CI, 0.63 to 0.85; P < 0.0001) rather than those with CVD (OR, 1.10, 95% CI, 0.91 to 1.34, P = 0.34). CAN risk was decreased by intensive blood pressure (BP) intervention (OR, 0.75; 95% CI, 0.63 to 0.89; P = 0.001), particularly in patients aged 65 and older (OR, 0.66; 95% CI, 0.49 to 0.88; P = 0.005). There was no significant effect observed between fenofibrate and CAN (OR, 0.91; 95% CI, 0.78 to 1.07; P = 0.26). “The finding of possible heterogeneity in the effectiveness of intensive glycemic control based on CVD history, and of BP control based on age, may allow personalization of this treatment to maximize its cost-effectiveness,” the authors write.
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