What is the evidence that reduced glycemia decreases the short-term risk of macrovascular events, including stroke, in patients with type 2 diabetes mellitus?
From the available clinical trial results, there is no evidence that reduced glycemia decreases the short-term risk of macrovascular events, including stroke, in patients with type 2 diabetes mellitus. The Action in Diabetes and Vascular Disease: Preterax and Diamacron MR Controlled Evaluation (ADVANCE) Trial and the Veterans Affairs Diabetes Trial both showed no difference in the number of macrovascular events, including stroke, between groups with more intensive versus standard therapy. A glycated hemoglobin goal of <7.0% has been recommended by the American Diabetes Association to prevent long-term microangiopathic complications, but whether control to this level also reduces the long-term risk of stroke requires further study.