People with type 2 diabetes face many health risks, and one of the most dangerous but often overlooked complications is called cardiovascular autonomic neuropathy (CAN).
This condition affects the nerves that control the heart and blood vessels and can be life-threatening. It is also difficult to diagnose in its early stages.
Now, new research shows that keeping blood sugar and blood pressure under tighter control can lower the risk of developing CAN.
The study, published in the journal *Diabetes Care*, was led by Dr. Alessandro Doria from the Joslin Diabetes Center and Harvard Medical School, along with Dr. Rodica Pop Busui from the University of Michigan.
The researchers found that patients who followed intensive treatment to lower their blood sugar reduced their risk of CAN by 17%. Those who received intensive blood pressure treatment saw their risk reduced by 22%.
Interestingly, the benefits were not the same for everyone. Lowering blood sugar helped the most in people who did not already have heart disease, while lowering blood pressure had the strongest effect in people over the age of 65. This suggests that treatments can be tailored depending on a patient’s age and medical history.
The findings came from a detailed analysis of data collected during the large ACCORD trial (Action to Control Cardiovascular Risk in Diabetes). This study originally looked at whether intensive control of blood sugar, blood pressure, and cholesterol could reduce heart disease in people with type 2 diabetes who were at high risk.
The researchers reviewed data from about 7,000 people who had at least two assessments for CAN during the study. On average, patients were followed for about five years.
They found that lowering blood sugar levels close to normal, as measured by HbA1c, was linked to a meaningful drop in CAN risk. Intensive blood pressure treatment also clearly helped, while a cholesterol-lowering drug called fenofibrate did not make a difference. These results held true even after accounting for other risk factors.
The study also showed that combining intensive blood sugar and blood pressure treatments did not provide extra protection compared to intensive blood pressure treatment alone. This raises the idea that a more personalized approach to treatment may be best, rather than pushing all patients toward the same targets.
However, the researchers warn that tighter blood sugar control does not come without risks. In the original ACCORD trial, people receiving very intensive glucose-lowering treatment did see fewer non-fatal heart problems, but they also had a higher overall death rate. This highlights the need to balance benefits against potential harms and costs.
Despite this, the study provides strong evidence that intensive management of blood pressure and blood sugar can help prevent CAN in people with type 2 diabetes.
Dr. Doria said the results confirm what smaller studies had suggested and prove that these strategies can work. Dr. Busui emphasized the importance of the findings, pointing out that CAN is a strong predictor of early death and serious heart problems.
Overall, this research shows that managing blood sugar and blood pressure more carefully can protect against one of the most dangerous complications of diabetes. The challenge now is to find the safest and most effective way to tailor these treatments to individual patients.
The study is published in Diabetes Care.
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