Long-term mortality with intensive glucose lowering in DM2

January 01, 0001

Long-term mortality with intensive glucose lowering in DM2

This follow-up report of the ACCORD study by Canadian and US investigators describes the 5-year outcomes of a mean of 3.7 years of intensive glucose lowering on mortality and key cardiovascular events. They randomly assigned participants with type 2 diabetes and cardiovascular disease or additional cardiovascular risk factors to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level of 7 to 7.9%). After termination of the intensive therapy, due to higher mortality in the intensive-therapy group, the target glycated hemoglobin level was 7 to 7.9% for all participants, who were followed until the planned end of the trial.

They found: "Before the intensive therapy was terminated, the intensive-therapy group did not differ significantly from the standard-therapy group in the rate of the primary outcome (a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes), but had more deaths from any cause (primarily cardiovascular) (hazard ratio, 1.21) and fewer nonfatal myocardial infarctions (hazard ratio, 0.79). These trends persisted during the entire follow-up period (hazard ratio for death, 1.19 and hazard ratio for nonfatal myocardial infarction, 0.82). After the intensive intervention was terminated, the median glycated hemoglobin level in the intensive-therapy group rose from 6.4% to 7.2%, and the use of glucose- lowering medications and rates of severe hypoglycemia and other adverse events were similar in the two groups."

The authors concluded: "As compared with standard therapy, the use of intensive therapy for 3.7 years to target a glycated hemoglobin level below 6% reduced 5-year nonfatal myocardial infarctions but increased 5-year mortality. Such a strategy cannot be recommended for high-risk patients with advanced type 2 diabetes."

Here is more evidence that intensive glucose-lowering therapy does not benefit patients with diabetes type 2.

For the full abstract, click here.

N Engl J Med 364:818-828, 3 March 2011
© 2011 to the Massachusetts Medical Society
Long-Term Effects of Intensive Glucose Lowering on Cardiovascular Outcomes. The ACCORD Study Group. Correspondence to Dr. Gerstein: gerstein@mcmaster.ca

Category: T. Endocrine/Metabolic/Nutritional, K. Circulatory. Keywords: diabetes mellitus type 2, glycated hemoglobin, intensive glucose lowering, mortality, follow-up report of randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 29 March 2011

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