March 3rd, 2011

5-Year Followup of ACCORD: Still No Support For Intensive Glucose Lowering

Long-term followup of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial has once again failed to support routine intensive glucose lowering in high-risk type 2 diabetics. In 2008, as reported in the New England Journal of Medicine, the intensive glucose-lowering regimen (target glycated hemoglobin level of <6%) was terminated early after an increase in mortality was observed in that group, and all patients received standard glucose-control therapy (target glycated hemogloblin level of 7.0% to 7.9%).

Now, a new paper in NEJM reports the 5-year results of the trial, after 3.7 years of intensive glucose-lowering treatment and up to 17 months of additional followup. Mortality at 5 years was 19% higher in the intensive-control group (7.6% in the intensive-therapy group versus 6.4% in the standard-therapy group). By contrast, the incidence of nonfatal myocardial infarction was lower in the intensive-therapy group, although cardiovascular deaths were higher in this group.

In their conclusion, the ACCORD investigators write that the results “suggest a lower limit for glycemic targets, achieved with the use of multiple combinations of currently available approaches.”


2 Responses to “5-Year Followup of ACCORD: Still No Support For Intensive Glucose Lowering”

  1. Bruce Kottke, MD,PhD says:

    If the intensive treatment group had been treated with only glitizones, gliptins , metformin and Lantus insulin rather than sulfonoureas and a basal + sliding scale insulin strategy, the incidence of hypoglycemia ( detected and not detected) would have been much less and the benefits of intensive therapy would have been apparent.

    B.A. Kottke MDPhD,FACC
    Emeritus Professor of Medicine
    Mayo College of Medicine

    Competing interests pertaining specifically to this post, comment, or both:

  2. David Powell , md, facc says:

    Analysis of ACCORD has suugested that hypoglycemia is NOT the driver of negative outcomes in the intensive group. Maybe it is insulin use; but I don’t think we know. BARI 2D suggested equivalence of insulin providingvs. sensitizing approaches. Personally, I am a sensitizer.