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BACKGROUND	The Veterans Affairs Diabetes Trial previously showed that intensive glucose lowering , as compared with standard therapy , did not significantly reduce the rate of major cardiovascular events among 1791 military veterans ( median follow-up , 5.6 years ) .
BACKGROUND	We report the extended follow-up of the study participants .
METHODS	After the conclusion of the clinical trial , we followed participants , using central databases to identify procedures , hospitalizations , and deaths ( complete cohort , with follow-up data for 92.4 % of participants ) .
METHODS	Most participants agreed to additional data collection by means of annual surveys and periodic chart reviews ( survey cohort , with 77.7 % follow-up ) .
METHODS	The primary outcome was the time to the first major cardiovascular event ( heart attack , stroke , new or worsening congestive heart failure , amputation for ischemic gangrene , or cardiovascular-related death ) .
METHODS	Secondary outcomes were cardiovascular mortality and all-cause mortality .
RESULTS	The difference in glycated hemoglobin levels between the intensive-therapy group and the standard-therapy group averaged 1.5 percentage points during the trial ( median level , 6.9 % vs. 8.4 % ) and declined to 0.2 to 0.3 percentage points by 3 years after the trial ended .
RESULTS	Over a median follow-up of 9.8 years , the intensive-therapy group had a significantly lower risk of the primary outcome than did the standard-therapy group ( hazard ratio , 0.83 ; 95 % confidence interval [ CI ] , 0.70 to 0.99 ; P = 0.04 ) , with an absolute reduction in risk of 8.6 major cardiovascular events per 1000 person-years , but did not have reduced cardiovascular mortality ( hazard ratio , 0.88 ; 95 % CI , 0.64 to 1.20 ; P = 0.42 ) .
RESULTS	No reduction in total mortality was evident ( hazard ratio in the intensive-therapy group , 1.05 ; 95 % CI , 0.89 to 1.25 ; P = 0.54 ; median follow-up , 11.8 years ) .
CONCLUSIONS	After nearly 10 years of follow-up , patients with type 2 diabetes who had been randomly assigned to intensive glucose control for 5.6 years had 8.6 fewer major cardiovascular events per 1000 person-years than those assigned to standard therapy , but no improvement was seen in the rate of overall survival .
CONCLUSIONS	( Funded by the VA Cooperative Studies Program and others ; VADT ClinicalTrials.gov number , NCT00032487 . )

