Victor M. Montori, MD, MSc; German Malaga, MD
In patients with type 2 diabetes and cardiovascular disease or risk factors, does intensive glucose control prevent cardiovascular events more than standard glucose control?
Randomized controlled trial (Action to Control Cardiovascular Risk in Diabetes [ACCORD]).
Blinded (outcome adjudication committee and laboratory staff).*
Median 3.4 years (trial discontinued early because of increased mortality in the intervention group).
77 centers in the USA and Canada.
10 251 patients 40 to 79 years of age (mean age 62 y, 61% men) who had type 2 diabetes, glycated hemoglobin level ≥ 7.5%, and cardiovascular disease or, if ≥ 55 years of age, risk factors for cardiovascular disease. Exclusion criteria included body mass index > 45 kg/m2, serum creatinine level > 1.5 mg/dL (132 mmol/L), and frequent or recent serious hypoglycemia.
Intensive glucose control to achieve a target glycated hemoglobin level < 6.0% (n = 5128) or standard glucose control to achieve a target glycated hemoglobin level of 7.0% to 7.9% (n = 5123).
Composite of cardiovascular events (nonfatal myocardial infarction or stroke, or death from cardiovascular causes). Secondary outcomes included death from any cause and hypoglycemia requiring medical assistance.
98% (intention-to-treat analysis).
The Table shows results.
In patients with type 2 diabetes and cardiovascular disease or risk factors, intensive glucose control increased mortality and did not prevent cardiovascular events more than standard glucose control.
Intensive vs standard glucose control to prevent cardiovascular events in type 2 diabetes†
†Abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from data in article.
Montori VM, Malaga G. Intensive glucose control increased mortality and did not prevent cardiovascular events in type 2 diabetes. Ann Intern Med. ;149:JC3–7. doi: 10.7326/0003-4819-149-6-200809160-02007
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Published: Ann Intern Med. 2008;149(6):JC3-7.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Prevention/Screening.
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