Glucose Lowering to Control Macrovascular Disease in Type 2 Diabetes: Treating the Wrong Surrogate End Point?

In the 1920s, the use of insulin to treat type 1 diabetes was lifesaving for children in diabetic ketoacidosis. Among the surviving patients with diabetes, the microvascular and macrovascular disease complications proved to be nonetheless devastating. The treatment of type 1 diabetes was revolutionized by the discovery that intensive glycemic control could prevent or delay the development of the microvascular complications of retinopathy, neuropathy, and nephropathy. Indeed, for patients with type 1 diabetes, aggressive insulin treatment also reduced the long-term risk of cardiovascular disease.¹