Glycemic control and cardiovascular disease--should we reassess clinical goals?

Improved glycemic control reduces the risks of early microvascular complications, such as retinopathy, nephropathy, and neuropathy, in patients with diabetes.1,2 Such patients also have a markedly increased risk of macrovascular complications — myocardial infarction and stroke — as compared with persons without diabetes, and cardiovascular disease is the chief cause of death among patients with either type 1 or type 2 diabetes.3,4 The increased risk appears to be only partially explained by traditional risk factors. Whereas we recognize that the development of atherosclerosis is multifactorial, there is substantial evidence linking chronic hyperglycemia to an increased risk of cardiovascular . . .

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