Effect of Intensive Glycemic Control on Fibrinogen, Lipids, and Lipoproteins

Abstract

IT IS not clear whether near-normal glycemic control with insulin therapy can be attained and maintained in people with type 2 (non–insulin-dependent) diabetes mellitus and with previous suboptimal response to maximum-dose oral agents or to any dose of insulin. The Veterans Affairs Cooperative Study in Type II Diabetes Mellitus (VA CSDM) was conducted with 153 male veterans in 5 VA medical centers (VAMCs) to assess whether a statistically and clinically significant difference in glycosylated hemoglobin (Hb A_1c) levels could be safely achieved between standard- and intensive-treatment arms while maintaining Hb A_1c levels in both arms within a range that would be acceptable in regular community practice. Thus, our major purpose was to establish the feasibility of conducting a longer and larger study in men and women with type 2 diabetes mellitus who had failed to achieve glycemic regulation while receiving pharmacological therapy. In this feasibility trial, clinical and laboratory data concerning microvascular and macrovascular events, safety of intensive therapy, and quality of life were collected and analyzed. We report herein the effects of 2 years of intensive glycemic control on the following cardiovascular risk factors: levels of plasma fibrinogen, serum triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein B (Apo B), lipoprotein (a) (Lp[a]), high-density lipoprotein (HDL) cholesterol, and Apo A₁.