The Influence Of Strictly Lowering Glucose For Major Adverse Cardiovascular Events Of Type2Diabetes Mellitus And With Coronary Artery Disease

Objective:To investigate the influence for major adverse cardiovascular events of intensifying glucose control for the patients with type2diabetes mellitus and with coronary artery disease.Methods:A total of330patients with type2diabetes mellitus and with coronary heart disease were recruited in this study from The Second Hospital of Tianjin Medical University in2011-2012. Required to complete clinical data, detailed record in history of the basic situation, the result of clinical laboratory test and Echocardiography. According to expert consensus of Chinese adults with type2diabetes glycated haemoglobin A1C (HbA1C) control target,enrolled subjects were randomly divided into three groups to receive therapy for intensive glycaemia control(<6.5%, A),therapy for standard glycaemia control (6.5%-7.5%, B组) and therapy for loose glycaemia control(7.5%-8.5%, C组), observing the mortality and the occurrence of major adverse cardiovascular events(MACE) between three groups in one years, the MACE included cases of nonfatal Myocardial infarction(MI),Myocardial infarction again, nonfatal stroke,congestive heart failure, microangiopathy and sudden death. The decision criterion of hypoglycaemia: unconsciousness, seizures, coma, myocardial ischaemia, angina or death; the number of blood sugar values below3.9mmol/l was determined from the finger stick glucose; severe hypoglycaemia which the number of blood glucose concentration of less than2.8mmol/l,and recovery with carbohydrate treatment Intravenous glucosen Muscle or subcutaneous injection with glucagon.Results:There was significant difference of the total incidence of MACE between the groups,,But there was on significant differences of the major vascular events and mortality between the groups,such as nonfatal Myocardial infarction(MI),stroke. Further pairwise comparison, the total incidence of MACE and microvascular events were lower in intensive glycaemia control group compared with the standard glycaemia control and loose glycaemia control group, and there was significant difference, There was significant statistical difference of the glycopenia events between the groups, the incidence of glycopenia events were greater in intensive glycaemia control group compared with the standard glycaemia control and loose glycaemia control group.Conclusions:Strictly lowering glucose can significantly reduced the incidence of MACE of type2diabetes mellitus and with coronary artery disease,but can not significantly reduced major vascular events,moreover,it increased the incidence of glycopenia events.