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.”