Ten-year posttrial monitoring from the landmark United Kingdom Prospective Diabetes Study (UKPDS) indicates that a strategy of early intensive glucose lowering, either with a sulfonylurea or metformin, has lasting, significant effects not only on major diabetes end points but also on risk of myocardial infarction (MI) or all-cause mortality. One of the "most plausible" theories as to why the recent Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular disease (ADVANCE), and Veterans Administration Diabetes (VADT) trials showed no benefit of glucose control on cardiovascular outcomes was that the glucose control was too late and could not "stop the moving train."By contrast, blood-pressure benefits seen with "tighter" blood-pressure lowering in 1997, when the trial first concluded, were not maintained over time.
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