Critical Appraisal Intensive glycemic control Implications of the ACCORD, ADVANCE, and VADT trials for family physicians

Research question How does intensive glycemic control affect cardiovascu-lar (CV) outcomes in patients with type 2 diabetes? Relevance to family physicians Type 2 diabetes is an important health problem all over the world. The incidence of CV events is 2 to 4 times higher in patients with diabetes than in those without diabe-tes. Approximately 80 % to 90 % of people with diabetes are primarily managed by family physicians, in Canada and around the world. Owing to results of recent trials, family physicians should make sure their knowledge is up-to-date to ensure better glycemic management. We have long known that intensive glycemic control reduces diabetes-related complications, including CV events. Some studies, like the DCCT (Diabetes Control and Complications Trial)1 and the UKPDS (United Kingdom Prospective Diabetes Study),2 have clearly shown a direct relationship between glycosylated hemoglobin A1c (HbA1c) levels and incidence of CV disease, and that intensive glycemic control might lead to reduction in risk of all CV events, including nonfatal myocardial infarction, stroke, and sudden death. On the basis of these and other trials, both the Canadian Diabetes Association and the America