{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T19:39:14Z","timestamp":1776109154875,"version":"3.50.1"},"reference-count":31,"publisher":"Baishideng Publishing Group Inc.","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World J Diabetes"],"abstract":"<jats:p>BACKGROUND<\/jats:p>\n                  <jats:p>Achieving optimal glycemic control is a cornerstone of cardiovascular risk reduction in type 2 diabetes (T2D). However, the extent to which multifactorial interventions influence this relationship remains uncertain.<\/jats:p>\n                  <jats:p>AIM<\/jats:p>\n                  <jats:p>To evaluate the association between glycated hemoglobin (HbA1c) target achievement and long-term cardiovascular outcomes in patients receiving standard of care (SoC) or multifactorial intensive therapy (MT).<\/jats:p>\n                  <jats:p>METHODS<\/jats:p>\n                  <jats:p>This post-hoc  analysis of the nephropathy in diabetes type 2 cluster-randomized trial included 323 patients with T2D, albuminuria, and retinopathy (SoC: n  = 139; MT: n  = 184), who underwent a 4-year intervention phase. Outcomes were major adverse cardiovascular events (MACE) and all-cause mortality. Associations with HbA1c target achievement (\u2264 7% vs  &gt; 7%) were assessed using Kaplan-Meier curves and shared frailty Cox regression models.<\/jats:p>\n                  <jats:p>RESULTS<\/jats:p>\n                  <jats:p>During a median follow-up of 12.1 years, 190 MACEs and 139 deaths occurred. Achievement of the HbA1c target was not associated with reduced mortality in either group. However, a significant reduction in MACEs was observed only among SoC patients achieving HbA1c \u2264 7% (P  = 0.031), whereas no benefit was seen in the MT group (P  = 0.645). In multivariable Cox regression models adjusted for cluster effect, in the MT group age [hazard ratio (HR) = 1.07, P  &lt; 0.001] and female sex (HR = 0.38, P  &lt; 0.001) were independent predictors of MACE, while in the SoC group only age (HR = 1.04, P  = 0.009). For all-cause mortality, age (HR = 1.11, P  &lt; 0.001) and blood pressure control (HR = 0.55, P  = 0.041) were significant predictors in the MT group, whereas age (HR = 1.06, P  = 0.002) was independently associated with increased mortality in the SoC group.<\/jats:p>\n                  <jats:p>CONCLUSION<\/jats:p>\n                  <jats:p>In high-risk patients with T2D receiving standard care, achieving an HbA1c \u2264 7% was associated with fewer cardiovascular events only under standard care, but not with reduced mortality. This association was not observed in patients managed with a multifactorial strategy. These findings suggest that the prognostic value of glycemic control depends on the broader treatment context and highlight the central role of comprehensive risk factor management in microvascular-complicated T2D.<\/jats:p>","DOI":"10.4239\/wjd.v16.i11.111698","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T02:10:51Z","timestamp":1763086251000},"source":"Crossref","is-referenced-by-count":1,"title":["Impact of achieving glycated hemoglobin targets on cardiovascular events\/mortality:\n                    <i>Post-hoc<\/i>\n                    analysis of the nephropathy in diabetes type 2 trial"],"prefix":"10.4239","volume":"16","author":[{"given":"Alfredo","family":"Caturano","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vittorio","family":"Simeon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffaele","family":"Galiero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Russo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"De Nicola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Chiodini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Rinaldi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica","family":"Vetrano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Salvatore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina","family":"Conte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Acierno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celestino","family":"Sardu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffaele","family":"Marfella","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Minutolo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ferdinando C","family":"Sasso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2060","published-online":{"date-parts":[[2025,11,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01301-6"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-019-1107-y"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.039100"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60484-9"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz486"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-021-01343-1"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-024-02371-3"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-022-01674-7"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0802743"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0802987"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0808431"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0806470"},{"key":"B13","doi-asserted-by":"crossref","unstructured":"American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2005; S4-S36","DOI":"10.2337\/diacare.28.suppl_1.S4"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/00004872-200306000-00001"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/s0195-668x(03)00347-6"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy462"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.4158\/EP.12.S1.89"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.12659\/msm.903660"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0162652"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24119352"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-10215-7"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-12-200912150-00005"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1111\/dom.15511"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00537-3"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad192"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2025.112050"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.06.016"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.02.030"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.3390\/ijms20153775"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.31083\/j.rcm.2021.01.256"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1177\/2047487319878371"}],"container-title":["World Journal of Diabetes"],"original-title":[],"link":[{"URL":"https:\/\/www.wjgnet.com\/1948-9358\/full\/v16\/i11\/111698.htm","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.wjgnet.com\/1948-9358\/full\/v16\/i11\/111698.htm","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T02:11:14Z","timestamp":1763086274000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.wjgnet.com\/1948-9358\/full\/v16\/i11\/111698.htm"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,15]]},"references-count":31,"journal-issue":{"issue":"11"},"alternative-id":["111698"],"URL":"https:\/\/doi.org\/10.4239\/wjd.v16.i11.111698","relation":{},"ISSN":["1948-9358"],"issn-type":[{"value":"1948-9358","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11,15]]}}}