What is the benefit of intensive glucose control on macrovascular end points such as stroke?
No macrovascular benefit was demonstrated in the main publications from DCCT, the UKPDS, or 3 other more recent trials designed to test intensive control for prevention of macrovascular disease.239 241 However, a benefit of intensive control emerged during long-term follow-up of the DCCT242 and the UKPDS. Two meta-analysis of 5 trials that included the UKPDS reported a benefit of intensive control for some cardiovascular outcomes but not for stroke.243,244 No trials or meta-analyses have reported the effect of intensive control on patients with a history of stroke. Many experts conclude that the benefit of intensive control on macrovascular disease is likely restricted to younger patients with recent-onset diabetes and without established vascular disease.