Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial—Clinical Implications

[摘要] Patients with type 2 diabetes are at high risk for several serious health problems, including premature death, cardiovascular disease (CVD),2 blindness, and kidney failure. Moreover, there is a strong positive association between the degree of glycemia, measured as plasma glucose or glycated hemoglobin (Hb A1c), and the above outcomes. Hence, it has been hypothesized that the mortality and morbidity of type 2 diabetes can be reduced with intensive control of glycemia.The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial tested this hypothesis by determining whether a therapeutic strategy that targeted a typical Hb A1c value of <6.0%, compared with a strategy that targeted an Hb A1c value of 7.0%–7.9%, would reduce CVD (1). The primary outcome was a composite of CVD death, nonfatal myocardial infarction, and nonfatal stroke. Secondary outcomes included all-cause mortality, development and progression of microvascular disease, frequency of severe hypoglycemia, and progression of retinopathy. The trial also tested the effects of intensive blood pressure (BP) control and the addition of a fibrate in selected patients.The study randomized 10 251 participants with well-established type 2 diabetes. Entry criteria included a history of a cardiovascular event or at least 2 risk factors for CVD, and a normal serum creatinine concentration.The trial was not designed to test the efficacy of any particular medication or combination of medications. What differed between the 2 arms was the glycemic target and consequently the frequency of use of glycemia medications and, to a lesser extent, the dosage. All participants made frequent clinic visits, during which lifestyle education and hypoglycemia prevention were emphasized.Within 8 months after enrollment, the median Hb A1c values in the intensive and standard glycemia arms reached 6.4% and 7.5%, respectively, and remained stable with a difference between the medians of 1.1% …

[学科分类] 过敏症与临床免疫学