In a new study, researchers found that intensive treatments to reduce blood glucose and blood pressure levels in type 2 diabetes reduce the risk of developing cardiovascular autonomic neuropathy (CAN).
This is a frequent but under-diagnosed complication of diabetes that can be life-threatening.
The researchers found that intensive glycemic control reduced CAN risk by 17%, while intensive blood pressure control reduced risks by 22%.
They also found that intensive control of blood glucose was more effective in individuals with no history of heart disease and that blood pressure lowering was more effective in individuals older than 65 years.
The research was conducted by a team from the Joslin Diabetes Center, Harvard Medical School, and elsewhere.
In the study, the team looked at the effects on CAN of intensive glucose treatment, intensive blood pressure treatment, and fenofibrate (a lipid lowering agent), compared to standard treatments.
None of the interventions (intensive and standard care) involved the newer drug class of SGLT2 inhibitors and only a few participants received GLP1-receptor agonists towards the end of the trial.
The average follow-up was about five years.
The team found that intensive treatment to reduce HbA1c (a measure of blood glucose levels) to near normal levels resulted in a 17% reduced risk for CAN compared to standard treatment.
The same direction of effect was found for the intensive treatment of raised blood pressure.
That approach resulted in a 22% reduced risk for CAN compared to standard treatment approaches.
Treatment with fenofibrate and a statin compared to placebo and a statin was not as successful, with no difference between the interventions.
Additional analyses based on subgrouping showed that the protective effects of intensive treatment of glycemia on CAN risk were only found in individuals without a history of heart disease but not in individuals with such a history.
Blood pressure interventions were especially strong in older adults over the age of 65 years where CAN risk was reduced by 34%.
Taken together, these findings point towards the possible personalization of risk reduction strategies, but more research will be needed to confirm the usefulness of these approaches.
One author of the study is Alessandro Doria, MD, Ph.D., MPH.
The study is published in Diabetes Care.
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