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Dr G Vijaya Kumar, Chennai 27 November 2018

The Veterans Affairs Diabetes Trial (VADT) randomly assigned 1791 military veterans who had a suboptimal response to T2DM therapy to receive either intensive or standard glucose control. About 40% of the patients had already had a CV event.
At 15 years, non-statistical 12% decline in the primary CV outcomes, and statistically significant 20% reduction in composite kidney outcomes was found in the intensive treatment group. In primary eye events, statistically significant 13% reduction in composite outcomes was noted in the intensive treatment group.
At 10 years, there was a statistically significant reduction in the CV events which did not persist at 15 years. The glucose control also declined to the level of standard arm.
Is there loss of legacy effect? We need to realize that in VADT, high risk population is included. At the end of 15 years, they were close to 80 yrs. About 40% had CVD, HbA1c was 9.4 and >11 years of diabetes at baseline.
CV benefits take a fair amount of time. As glucose separation between the treatment groups for VADT was greater and lasted for extended period of time, this provided an excellent opportunity to extend the legacy effect.
These results suggest that there are modest long-term CV benefits with good control of diabetes. Substantial and continuous glucose separation may be required to maintain these improvements.
It depends on how you interpret. Glucose control helps.

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