This study compared mortality from ischemic heart disease (IHD) in a cohort of newly diagnosed diabetic patients (n=205) matched to non-diabetic subjects (n=205) at baseline and followed for 20 years. After adjusting for potential confounders, IHD mortality was significantly increased in the diabetes group compared to subjects without diabetes (hazard ratio: 1.8, 95% CI: 1.0-3.4). Moreover, after multivariate adjustment, diabetic patients in the highest quartile of HbA1c were at greater risk of death from IHD compared to the reference group (hazard ratio: 4.2, 95% CI: 2.1-8.1). Finally, after having excluded patients with prevalent cardiovascular disease at baseline, analysing HbA1c as a continuous variable showed 30% higher risk of IHD mortality per increment HbA1c among diabetic patients. This paper was accompanied by an editorial written by Bartnik and Cosentino who recognized that the strength of the study by Dale et al. is the annual measurement of HbA1c in subjects with newly diagnosed diabetes during the 10 years following recruitment which allows assessment of how risk may vary according to glycemic burden over years. However, further studies are needed with longer follow-ups in order to properly assess the benefits of targeting normal glycemic levels in patients with type 2 diabetes and to verify whether this may apply to all patients or to only subgroups of patients.
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