Hyperglycaemia is associated with increased risk of cardiovascular complications in people with type 2 diabetes. The researchers from the USA and Canada investigated whether reduction of blood glucose concentration decreases the rate of microvascular complications in people with type 2 diabetes. ACCORD was a parallel-group, randomised trial done in 77 clinical sites in North America. People with diabetes, high HbA1c concentrations (greater than 7·5%), and cardiovascular disease (or 2 or more cardiovascular risk factors) were randomly assigned by central randomisation to intensive (target haemoglobin A1c:HbA1c of less than 6·0%) or standard (7·0—7·9%) glycaemic therapy. Investigators and participants were aware of treatment group assignment. 10,251 patients were randomly assigned, 5128 to the intensive glycaemia control group and 5123 to standard group.
Intensive therapy was stopped before study end because of higher mortality in that group, and patients were transitioned to standard therapy. Intensive therapy did not reduce the risk of advanced measures of microvascular outcomes, but delayed the onset of albuminuria and some measures of eye complications and neuropathy. Seven secondary measures at study end favoured intensive therapy (significant).
The researchers concluded: "Microvascular benefits of intensive therapy should be weighed against the increase in total and cardiovascular disease-related mortality, increased weight gain, and high risk for severe hypoglycaemia."
A tight-rope to walk whilst doing a balancing act.
For the full abstract, click here.
The Lancet published online 29 June 2010 © 2010 Elsevier Ltd
Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Dr Faramarz Ismail-Beigi, Timothy Craven, Mary Ann Banerji et al for the ACCORD trial group. Correspondence to Dr Faramarz Ismail-Beigi: faramarz.ismail-beigi@case.edu
Category: T. Endocrine/Metabolic/Nutritional. Keywords: intense, treatment, effect, hyperglycaemia, microvascular, outcomes, type 2 diabetes, ACCORD, randomized trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 23 July 2010
