People living with type 2 diabetes face many serious health complications, including heart disease, kidney damage, vision loss, and nerve problems.
One of the lesser-known but especially dangerous complications is called cardiovascular autonomic neuropathy, or CAN.
This condition affects the nerves that control the heart and blood vessels, making it harder for the body to regulate important functions such as heart rate and blood pressure.
CAN can increase the risk of serious health problems, including irregular heartbeats, fainting, heart attacks, and even sudden death. Unfortunately, the condition is often difficult to detect in its early stages because symptoms may develop slowly or go unnoticed for years.
Now, a major new study suggests that carefully controlling blood sugar and blood pressure may help reduce the risk of developing this dangerous condition in people with type 2 diabetes.
The study was published in the medical journal Diabetes Care. It was led by Dr. Alessandro Doria from the Joslin Diabetes Center and Harvard Medical School, together with Dr. Rodica Pop Busui from the University of Michigan.
The researchers found that people who received intensive treatment to lower their blood sugar reduced their risk of developing CAN by 17%. Patients who received intensive treatment to lower blood pressure reduced their risk by 22%.
The findings provide important evidence that managing diabetes more carefully may help protect the nervous system as well as the heart.
Type 2 diabetes affects hundreds of millions of people worldwide. Over time, high blood sugar can damage blood vessels and nerves throughout the body.
While many people are familiar with diabetic nerve damage affecting the feet or hands, CAN involves damage to the autonomic nervous system, which controls automatic body functions that people do not consciously manage.
When the nerves controlling the heart and circulation become damaged, the body may struggle to regulate blood pressure, heart rhythm, and blood flow properly. Some people with CAN may feel dizzy when standing up, experience exercise intolerance, or develop dangerous heart-related complications.
Researchers say CAN is especially concerning because it strongly predicts early death and major cardiovascular events in people with diabetes.
The new findings came from a detailed analysis of data collected during the large ACCORD trial, short for Action to Control Cardiovascular Risk in Diabetes.
This major clinical study originally investigated whether intensive treatment of blood sugar, blood pressure, and cholesterol could lower the risk of heart disease in people with type 2 diabetes who were already at high cardiovascular risk.
For the new analysis, the researchers reviewed information from around 7,000 participants who underwent at least two assessments for CAN during the study period. On average, participants were followed for about five years.
The scientists found that lowering blood sugar levels close to normal, based on HbA1c measurements, helped reduce the risk of CAN. HbA1c is a blood test that reflects average blood sugar levels over the previous two to three months and is commonly used to monitor diabetes control.
Intensive blood pressure treatment also showed clear protective effects. However, a cholesterol-lowering medication called fenofibrate did not appear to reduce the risk of CAN.
Interestingly, the benefits of treatment were not the same for all patients. Intensive blood sugar control worked best for people who did not already have cardiovascular disease. Meanwhile, intensive blood pressure control appeared to help older adults the most, especially people over the age of 65.
These findings suggest that a personalized treatment approach may be more effective than using the same strict targets for every patient.
The study also produced another important finding. Combining intensive blood sugar control with intensive blood pressure treatment did not provide more protection than intensive blood pressure treatment alone.
This suggests there may be limits to how aggressively doctors should try to control blood sugar in some patients.
The researchers stressed that tighter blood sugar control can sometimes carry risks. In the original ACCORD trial, patients receiving very intensive glucose-lowering treatment experienced fewer non-fatal cardiovascular events, but they also showed a higher overall death rate.
This surprising result raised concerns among doctors about pushing blood sugar levels too low too quickly in certain high-risk patients.
Because of this, experts say treatment decisions should always carefully balance possible benefits with potential risks and side effects.
Dr. Doria explained that the study confirms what earlier smaller studies had suggested — that better control of blood sugar and blood pressure can help protect against CAN.
Dr. Busui emphasized the importance of the findings because CAN is strongly linked to severe heart complications and early death in people with diabetes.
The researchers believe the study highlights the growing importance of individualized diabetes care.
Rather than using the same treatment goals for everyone, doctors may need to consider a patient’s age, heart health, medical history, and overall risk profile when deciding how aggressively to manage blood sugar and blood pressure.
As rates of type 2 diabetes continue to rise around the world, preventing complications such as CAN has become a major public health goal. Early prevention may not only improve quality of life but also reduce the risk of life-threatening heart problems later on.
The study adds to growing evidence that careful management of diabetes can protect much more than blood sugar levels alone. By controlling blood pressure and blood sugar in safer and more personalized ways, doctors may be able to help patients avoid one of the most dangerous hidden complications of diabetes.
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