Intensive interventions to reduce blood glucose and blood pressure levels in type 2 diabetes reduce the risk of developing cardiovascular autonomic neuropathy (CAN), a frequent but underdiagnosed complication of diabetes that can be life-threatening.
In the recent study researchers found that intensive glycemic control reduced CAN risk by 17%, while intensive blood pressure control reduced risks by 22%. They also found that intensive control of blood glucose was more effective in individuals with no history of cardiovascular disease (CVD) and that blood pressure lowering was more effective in individuals older than 65 years, suggesting that some degree of personalization of risk reduction might be possible.
Intensive treatment reduced HbA1c (a measure of blood glucose levels) to near normal levels resulted in a 17% reduced risk for CAN compared to standard treatment, and that was after adjusting the risk model for a very broad spectrum of confounding factors, including all traditional CAN and cardiovascular disease risk factors. The same direction of effect was evident for the intensive treatment of raised blood pressure. That approach resulted in a 22% reduced risk for CAN compared to standard treatment approaches after adjusting for confounding factors. Treatment with fenofibrate and a statin compared to placebo and a statin was not as successful, with no significant difference between the interventions.
The current study proves that simple interventions like glucose level and blood pressure control may reduce severe consequences of diabetes like neuropathy.
Intensive Risk Factor Management and Cardiovascular Autonomic Neuropathy in Type 2 Diabetes: The ACCORD Trial
The effects of preventive interventions on cardiovascular autonomic neuropathy (CAN) remain unclear. We examined the effect of intensively treating traditional risk factors for CAN, including hyperglycemia, hypertension, and dyslipidemia, in individuals with type 2 diabetes (T2D) and high cardiovascular risk participating in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
RESEARCH DESIGN AND METHODS CAN was defined as heart rate variability indices below the fifth percentile of the normal distribution. Of 10,251 ACCORD participants, 71% ( n = 7,275) had a CAN evaluation at study entry and at least once after randomization. The effects of intensive interventions on CAN were analyzed among these subjects through generalized linear mixed models.
As compared with standard intervention, intensive glucose treatment reduced CAN risk by 16% (odds ratio [OR] 0.84, 95% CI 0.75–0.94, P = 0.003)—an effect driven by individuals without cardiovascular disease (CVD) at baseline (OR 0.73, 95% CI 0.63–0.85, P < 0.0001) rather than those with CVD (OR 1.10, 95% CI 0.91–1.34, P = 0.34) (Pinteraction = 0.001). Intensive blood pressure (BP) intervention decreased CAN risk by 25% (OR 0.75, 95% CI 0.63–0.89, P = 0.001), especially in patients ≥65 years old (OR 0.66, 95% CI 0.49–0.88, P = 0.005) (Pinteraction = 0.05). Fenofibrate did not have a significant effect on CAN (OR 0.91, 95% CI 0.78–1.07, P = 0.26).
These data confirm a beneficial effect of intensive glycemic therapy and demonstrate, for the first time, a similar benefit of intensive BP control on CAN in T2D. A negative CVD history identifies T2D patients who especially benefit from intensive glycemic control for CAN prevention.