TITLE

2011 - Intensive glucose control increased mortality and did not prevent CV events compared with standard glucose control in type 2 diabetes

AUTHOR(S)
Grubina, Rozalina; Smith, Steven A.
PUB. DATE
May 2011
SOURCE
ACP Journal Club;5/15/2011, Vol. 154 Issue 5, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Question In patients with type 2 diabetes who are at high cardiovascular (CV) risk, what are the long-term CV effects of intensive compared with standard glucose control? Methods Design Randomized controlled trial (Action to Control Cardiovascular Risk in Diabetes [ACCORD] study). ClinicalTrials.gov NCT00000620. Allocation {Concealed}*.† Blinding Blinded (outcome adjudication committee {and laboratory staff}*).† Follow-up period Mean 4.7 years for the primary outcome; mean 5 years for vital status. Setting 77 centers in the USA and Canada. Patients 10>251 patients 40 to 79 years of age ({mean age 62 y, 61% men}*) who had type 2 diabetes, glycated hemoglobin (HbA[sub 1c]) level >7.5%, and CV disease or risk factors for CV disease. Intervention Intensive glucose control to achieve a target HbA[sub 1c] level <>6% (n =>5128) or standard glucose control to achieve a target HbA[sub 1c] level of 7% to 7.9% (n =>5123). Intensive therapy was stopped at a mean 3.7 years of treatment because of increased mortality, and patients were switched to standard therapy (treatment transition) for the remainder of the trial. Outcomes Primary outcome was a composite CV endpoint (nonfatal myocardial infarction [MI] or stroke, or death from CV causes). Other outcomes included all-cause mortality. Patient follow-up 92% for primary outcome; 96% for vital status (intention-to-treat analysis). Main results At treatment transition, median HbA[sub 1c] levels were 6.4% in the intensive group and 7.5% in the standard group; at study end, levels were 7.2% and 7.6%, respectively. The main results at study end are shown in the Table; results were similar at treatment transition. Conclusion In patients with type 2 diabetes and high cardiovascular (CV) risk, intensive glucose control increased mortality and did not prevent a composite of CV events compared with standard control.
ACCESSION #
64279644

 

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