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Prioritizing early glycemic control to reduce microvascular and macrovascular complications in people with type 2 diabetes

The growing increase in prevalence of type 2 diabetes globally is escalating the burden of microvascular and macrovascular complications which will become more noticeable in the coming decades. As shown in the article published in Diabetes Care scientific journal, the key priority in the management of type 2 diabetes should be the use of glucose-lowering therapies which achieve an early glycemic control in order to reduce the increasing complications in people with and without established atherosclerotic cardiovascular disease (ASCVD).

The authors of the article reviewed different meta-analysis that proved the correlation between high levels of HbA1c and the appearance of cardiovascular events. One of them analyzed 26 prospective cohort studies (3123 articles) and revealed that patients with type 2 diabetes that experience a 1 % increase in HbA1c, have 1.17 more risk for cardiovascular disease (95% CI 1.10–1.20), 1.15 more risk for all-cause mortality (95% CI 1.11–1.20), and 1.11 more risk for heart failure (95% CI 1.05–1.18) and stroke (95% CI 1.06–1.17).

On the other hand, a 1% reduction in HbA1c was associated with a significant 30% reduced risk for major adverse cardiovascular-events (MACE) (95% CI 17–40%). This result came from a meta-analysis that reviewed 10 randomized controlled trials of 92,400 participants with type 2 diabetes who were taking glucose-lowering therapies with low risk of hypoglycemia.

These results highlight the importance of achieving an early and sustained HbA1c control to prevent long-term cardiovascular complications.

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