The effect of intensive glucose lowering therapy among major racial/ethnic groups in the Veterans Affairs Diabetes Trial

Metabolism. 2015 Feb;64(2):218-25. doi: 10.1016/j.metabol.2014.10.010. Epub 2014 Oct 17.


Objective: To examine the effect of intensive glycemic control on cardiovascular disease events (CVD) among the major race/ethnic groups in a post-hoc analysis of the VADT.

Materials and methods: Participants included 1111 non-Hispanic Whites, 307 Hispanics and 306 non-Hispanic Blacks randomized to intensive or standard glucose treatment in VADT. Multivariable Cox proportional hazards models were constructed to assess the effect of intensive glucose treatment on CVD events among race/ethnic groups.

Results: Mean age was 60.4 years and median follow-up was 5.6 years. By design, modifiable risk factors were managed equally well in both treatment arms and only differed modestly between race/ethnic groups. HbA(1c) decreased significantly from baseline with intensive glucose treatment in each race/ethnic group, with a trend for a greater response in Hispanics (P=0.02 for overall comparison between groups). Intensive glucose treatment was associated with reduced risk of CVD events for Hispanics but not for others (hazard ratios ranged from 0.54 to 0.75 for Hispanics whereas they were consistently close to 1 for others). Sensitivity analyses with different definitions of race/ethnicity or limited to individuals free of previous known CVD yielded similar results.

Conclusions: The results of these analyses support the hypothesis that race/ethnicity is worthy of consideration when tailoring intensive treatment for individuals with long-standing type 2 diabetes. However, additional studies are needed to confirm the findings of this post-hoc analysis.

Trial registration: NCT00032487.

Keywords: CVD; Ethnicity; Intensive glycemic control; Race; Type 2 diabetes.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Black or African American
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / prevention & control*
  • Combined Modality Therapy
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / ethnology
  • Diabetes Mellitus, Type 2 / therapy*
  • Diabetic Angiopathies / complications
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / ethnology
  • Diabetic Angiopathies / prevention & control*
  • Diabetic Cardiomyopathies / complications
  • Diabetic Cardiomyopathies / epidemiology
  • Diabetic Cardiomyopathies / ethnology
  • Diabetic Cardiomyopathies / prevention & control*
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin / analysis
  • Hispanic or Latino
  • Hospitals, Veterans
  • Humans
  • Hyperglycemia / prevention & control*
  • Male
  • Middle Aged
  • Precision Medicine*
  • Proportional Hazards Models
  • Risk Factors
  • United States / epidemiology
  • White People


  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human

Associated data