Maintaining blood sugar levels under good control for many years can lower the risk of suffering a heart attack, stroke, heart failure, or gangrene-related amputation by about 17%, a major study has found. The study is published in the New England Journal of Medicine.

A team of researchers from the VA Center for Clinical Management Research and the University of Michigan Medical School studied 1,791 veterans with type 2 diabetes for almost 10 years after they signed up for a six-year blood sugar trial. In the trial, they were randomized to either achieve “tight” glucose control or regular care. They found that controlled blood sugar can help reduce cardiovascular risk but no effect was seen on the risk of death during the same time period. Control of both blood sugar and cardiovascular factors is important for a combined effect, the authors emphasized. Keeping a long-term HbA1c average of about 8 proved enough to achieve most of the cardiovascular benefit and many patients could safely maintain HbA1c about 7.

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A quartet of four drugs (metformin to control blood sugar, a statin to control cholesterol and lipids, a blood pressure medication, and an aspirin) has been shown to provide cardiovascular protection in patients with type 2 diabetes. This further combined with diet, quitting smoking, and exercise could prevent millions of patients from heart attacks, strokes, heart failure, amputations, blindness, nerve pain, numbness, and kidney failure.

They concluded that study findings should not be used to justify an A1c target of 7 for all patients with diabetes. Instead, clinicians and hospitals that use A1c as a measure of glucose control should also consider the patient’s risk of cardiac events, low blood sugar reactions, and necessary medications to lower glucose further.

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