The importance of glycated haemoglobin (HbA1c) and postprandial glucose (PPG) control on cardiovascular outcomes in patients with type 2 diabetes

Vascular complications are the leading cause of morbidity and mortality in type 2 diabetes. Cardiovascular disease is significantly more common in patients with type 2 diabetes than in non-diabetics, and accounts for more than two-thirds of deaths associated with the condition. Many physicians believe that hyperglycaemia is responsible, at least in part, for this additional risk. The benefit of improved glycaemic control on microvascular complications is well established and recent trials have attempted to clarify the role of glycaemic control on macrovascular outcomes. This article reviews the recent evidence from a post-interventional analysis of the UKPDS and the ACCORD, ADVANCE, VADT and HEART2D trials for an association between elevated blood glucose levels and vascular complications. The data suggest that improved glycaemic control has the potential to significantly reduce the risk of micro- and macrovascular disease when instigated early in the disease course. However, in more advanced diabetes, the benefits of improved control appear to be less evident. Recent studies have also suggested that controlling postprandial glucose may be an important component in the reduction of vascular complications. Taken together, these studies indicate that glycaemic control remains a key cornerstone in the management of type 2 diabetes.