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VADT
Veterans Affairs Diabetes Trial
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Author(s) |
(a) Abraira C, Duckworth W, McCarren M, Emanuele N, Arca D, Reda D, Henderson W
(b) Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, Zieve FJ, Marks J, Davis SN, Hayward R, Warren SR, Goldman S, McCarren M, Vitek ME, Henderson WG, Huang GD
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Title(s) |
(a) Design of the cooperative study on glycemic control and complications in diabetes mellitus type 2 Veterans Affairs Diabetes Trial
(b) Glucose control and vascular complications in veterans with type 2 diabetes
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Reference(s) |
(a) J Diabetes Complications 2003;17:314–22
(b) N Engl J Med 2009;360:129–39
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Disease |
Type 2 diabetes mellitus |
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Purpose |
To compare the effect of intensive vs standard glycaemic control on cardiovascular events in patients with type 2 diabetes |
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Study design |
Randomised |
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Follow-up |
Median 5.6 years
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Patients |
1791 patients (892 intensive treatment, 899 standard treatment), mean age 60.4 years, non-responsive (centrally measured HbA1c ≥ 7.5% or local HbA1c ≥ 8.3%) to a maximum dose of at least one oral antidiabetic drug and/or daily insulin injections
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Treatment regimen |
Both arms received step therapy: glimepiride or metformin plus rosiglitazone and addition of insulin or other oral agents to achieve HbA1c goal ≤ 6% (intensive arm) or 8–9% (standard arm)
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Concomitant therapy |
ASA, 81–325 mg/day. Counselling on diet, exercise, smoking cessation, BP control and cholesterol control. Antihypertensive and/or cholesterol-lowering medications at the discretion of the physician |
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Results |
The primary composite outcome of MI, stroke, death from cardiovascular causes, congestive heart failure, surgery for vascular disease, inoperable coronary artery disease and amputation for ischaemic gangrene occurred in 235 patients in the intensive therapy group and 264 patients in the standard therapy group (hazard ratio 0.88, 95% CI 0.74–1.05; p = 0.14). There was no significant difference between the groups in any component of the primary outcome or in all-cause mortality
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Comments |
This study has been the basis for a number of publications. A selection of references:
Coronary atherosclerosis and cardiovascular events
– Reaven PD et al, Diabetes 2009;58:2642–8
Coronary atherosclerosis and interleukin-6 levels
– Saremi A et al, Atherosclerosis 2009;203:610–4
Coronary atherosclerosis and retinopathy
– Reaven PD et al, Diabetes Care 2008;31:952–7
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