What evidence is there for 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.