Letter to the Editor: Cardiovascular outcomes in high-risk type 2 diabetes mellitus: Standard of care vs multifactorial intensive therapy

Abstract

The study by Caturano et al published in the recent issue of the World Journal of Diabetes focused on high-risk type 2 diabetes patients, particularly those with albuminuria and retinopathy. The key finding was that maintaining glycated hemoglobin A1c (HbA1c) levels at or below 7% was significantly associated with a reduced incidence of major adverse cardiovascular events (MACE) only in the standard care group, while this association was not evident in the intensive multifactorial treatment group. Additionally, there was a U-shaped relationship between continuous HbA1c levels and both MACE and all-cause mortality. However, the study had limitations, including the exclusion of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists and a focus on specific high-risk subgroups. These findings align with current guidelines and support a personalized management strategy for type 2 diabetes, emphasizing that comprehensive multifactorial intervention is more beneficial for improving long-term patient outcomes than solely targeting HbA1c levels.

Keywords: Type 2 diabetes mellitus; Glycated hemoglobin A1c; Standard of care; Multifactorial intensive therapy; Major adverse cardiovascular events; Mortality

Core Tip: The study by Caturano et al focused on high-risk type 2 diabetes patients and found that a hemoglobin A1c (HbA1c) level ≤ 7% was associated with a reduced incidence of major adverse cardiovascular events only in the standard care group, with no such association observed in the intensive multifactorial treatment group. Additionally, there was a U-shaped relationship between continuous HbA1c levels and adverse outcomes. The study has limitations, but the results support individualized management and emphasize that comprehensive intervention is superior to solely controlling HbA1c.