David C. Aron, MD, MS; Leonard M. Pogach, MD, MBA
In patients with type 2 diabetes who are at high cardiovascular (CV) risk, does intensive glucose control reduce microvascular complications more than standard glucose control?
Randomized controlled trial (Action to Control Cardiovascular Risk in Diabetes [ACCORD] trial). ClinicalTrials.gov NCT00000620.
Median 5 years.
77 centers in the USA and Canada.
10 251 patients 40 to 79 years of age (median age 62 y) who had type 2 diabetes mellitus, glycated hemoglobin (HbA1c) level ≥ 7.5%, and CV disease or, if ≥ 55 years of age, > 1 risk factor for CV disease. Exclusion criteria included body mass index > 45 kg/m2, serum creatinine > 133 µmol/L (1.5 mg/dL), and frequent or recent serious hypoglycemia.
Intensive glucose control to achieve a target HbA1c level < 6.0% (n = 5128) or standard glucose control to achieve a target HbA1c level of 7.0% to 7.9% (n = 5123). Intensive therapy was stopped at a median 3.7 years of follow-up because of increased mortality, and patients were transitioned to standard therapy (treatment transition) for the remainder of the trial.
Advanced microvascular disease (composite of end-stage renal disease or start of dialysis, renal transplantation, serum creatinine level > 292 µmol/L [3.3 mg/dL], or retinal photocoagulation or vitrectomy for diabetic retinopathy). Other outcomes included a secondary composite endpoint of advanced microvascular disease components or peripheral neuropathy (Michigan Neuropathy Screening Instrument score > 2.0).
99% (intention-to-treat analysis).
At study end, groups did not differ for either composite endpoint (Table); results were similar at treatment transition.
In patients with type 2 diabetes, intensive glucose control did not reduce a composite of advanced microvascular disease events more than standard glucose control.
Intensive vs standard glucose control in type 2 diabetes†
†Abbreviations defined in Glossary. RRR, NNT, and CI calculated from data in article.
‡End-stage renal disease or start of dialysis, renal transplantation, serum creatinine level > 292 µmol/L (3.3 mg/dL), or retinal photocoagulation or vitrectomy for diabetic retinopathy.
§Advanced microvascular disease components or Michigan Neuropathy Screening Instrument score > 2.0.
David C. Aron, Leonard M. Pogach. Intensive glucose control did not reduce a composite of microvascular events more than standard control in type 2 diabetes. Ann Intern Med. 2010;153:JC5–9. doi: 10.7326/0003-4819-153-10-201011160-02009
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Published: Ann Intern Med. 2010;153(10):JC5-9.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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