Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
The Limits of Intensive Glucose Lowering in T2D
Diabetes Care; ePub 2017 Dec 5; Koska, Saremi, et al
Lower levels of methionine sulfoxide (MetSO) and higher levels of select advanced glycation end products (AGE) are linked with increased cardiovascular disease, according to a study involving >700 individuals. Participants included a subcohort of the Veterans Affairs Diabetes Trial (VADT; n=445) and a nested case-control subgroup from the ACCORD study (n=271). Investigators measured 5 AGEs and 2 oxidation products (OPs) at baseline of each trial. Among the results:
- Increased levels of several AGEs and OPs were linked with older age, decreased kidney function, previous CVD, and longer diabetes duration.
- In VADT, increased risk of CVD events was linked with lower MetSO after adjusting for certain confounders.
- Also, patients with both low MetSO and high 3-deoxyglucosone hydroimidazolone concentrations were at highest risk for CVD.
- In ACCORD, patients with CVD events had lower MetSO even after adjusting for those events.
The authors noted that their findings may help explain the limits of intensive glucose lowering.
Koska J, Saremi A, Howell S, et al. Advanced glycation end products, oxidation products, and incident cardiovascular events in patients with type 2 diabetes. [Published online ahead of print December 5, 2017]. Diabetes Care. doi:10.2337/dc17-1740.