New research shows that intensive interventions to reduce blood pressure and blood glucose levels can reduce the risk of cardiovascular autonomic neuropathy (CAN) in those with type 2 diabetes. CAN is a frequent and underdiagnosed complication of diabetes that can be life-threatening.
The study published in Diabetes Care analyzed data from participants who were enrolled in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. The trial initially investigated the effects of intensive glycemic, blood pressure control, and lipid interventions on cardiovascular events in individuals with type 2 diabetes and high CVD risks.
The study’s authors included participants who had an evaluation for CAN at baseline and at least one more assessment after randomization. Out of the 7,000 participants, researchers looked at the effects of intensive glucose treatment, intensive blood pressure treatment, and fenofibrate (a lipid-lowering agent), compared to standard therapies.
The new class of diabetes drugs, SGLT2 inhibitors, were not used in any of the interventions, and only a few participants received GLP1-receptor agonists towards the end of the trial. The study ran from early 2001 to 2010 when these drugs were not widely used in clinical practice.
The study found that intensive treatment to reduce HbA1c (a measure of blood glucose levels) to near normal levels had resulted in a 17% reduced risk for CAN. The same was found for intensive treatment of raised blood pressure. This approach reduced the risk of CAN by 22%. Both results were compared to standard treatment and were adjusted for a broad spectrum of confounding factors, including all traditional CAN and cardiovascular risk factors.
Additional analysis showed that the protective effects of intensive treatment of glycemia was only found in individuals without a history of cardiovascular disease. Blood pressure interventions were especially evident in older adults over the age of 65 years, where CAN risk was reduced by 34%.
Senior co-author Dr. Alessandro Doria concluded the study by saying, “Based on previous smaller studies, we thought that intensive glycemic and blood pressure control would probably work, but these results provide us with definitive proof that these treatments can be used to prevent this serious complication of diabetes.”
Co-author of the study, Rodica Pop Busui added: “These findings have high clinical care relevance, as we have previously demonstrated that CAN, even in earlier stages, independently predicts cardiovascular and all-cause mortality in type 2 diabetes, and major cardiovascular events and heart failure in type 1 diabetes.”
The authors of this study suggest that it may be possible to create personalized risk reduction strategies with these findings. By combining intensive glycemic control and blood pressure control, physicians may be able to help patients control the risk of CAN more effectively. However, more research will be needed to confirm the usefulness of these approaches.