When is tight control too tight! The ACCORD study: what does it mean?

A safety analysis and the intensive glycemic control arm of the ACCORD study was halted. This you can read press release from NIH.
we have learned that intensive glycemic control reduces microvascular complications in DM-1 (DCCT) and in DM-2 (UKPDS)there’s been not a shred of evidence that it helps macrovascular disease (heart attacks and strokes) at least in DM-2. A very long follow up DCCTsuggested late macrovascular benefit in DM-1 but that’s a different disease entirely
Further analysis of UKPDS study hinted at macrovascular benefits (stroke only) attributable to drug metformin though not to intensive control, and only in patients with DM-2 who were obese and on metformin as initial monotherapy, not as add on.PROACTIVE study.
Finally with PROACTIVE study we begin to see evidence that treatment with Pioglitazone might offer macrovascular benefits. I believe this was a unique effect of pioglitazone via non-glycemic mechanisms such as favorable lipid effects, improvement in insulin resistance and improvement in endothelial function. Read my previous post.