The united kingdom prospective diabetes study ukpds, published in 1999, was the first major study to investigate targets for glucose control in patients with type 2 diabetes. The accord study data and biospecimens are now available in the nhlbi biological specimen and data repository information coordinating center biolincc overview of accord and accordion. Targeting this risk group, the memory in diabetes mind substudy embedded in the action to control cardiovascular risk in diabetes accord trial 5, 6 was designed to test the primary hypothesis that at 40 months, persons randomized to an intensive glycaemic therapeutic strategy targeting hba 1c to 2008 guidance in diabetes care the good, the bad, the ugly, and the future 3. We assessed 10 251 adults aged 4079 years with established type 2 diabetes, mean glycated haemoglobin a 1c hba 1c concentration of 67 mmolmol 83%, and risk factors for ischaemic heart disease enrolled in the accord trial. The results of the accord study are not surprising. Intensive glycemic control in the accord and advance. Followup study li et al, lancet 2008 0 10 20 30 40 50 60 70 80 90 100 012 34567 8910111214151617181920 followup years % with diabetes control group.
The 2008 action to control cardiovascular risk in diabetes accord trial randomized 10,251 patients with longstanding t2dm to either intensive hba1c jun 27, 2019 accord was a randomized cardiovascular clinical trial in 10,251 with type 2 diabetes who were treated and followed for an average of approximately 5 years from 2001 through mid2009. The accord action to control cardiovascular risk in diabetes. Effects of intensive glucose lowering in type 2 diabetes. Accord eye study in addition, there was another substudy of the accord trial called the accord eye study, which took a small subgroup of patients and looked at factors that contributed toward progression of diabetic retinopathy.
Accord diabetes trial intensive versus standard a1c targets in. Jensen june 12, 2008 accord diabetes trial1 intensive versus standard a1c targets in t2dm mortality with a very intensive glucose lowering strategy in high cv risk t2dm patients research question. At 4 years, there was a 33% reduction in retinopathy progression in the intensive arm 7. The study, known as the action to control cardiovascular risk in diabetes accord trial, is being conducted at 77 sites in north america. In the action to control cardiovascular risk in diabetes accord study, 10,251 patients with type 2 diabetes at high cardiovascular risk but with no history of frequent or. Re study undercuts diabetes theory front page, feb. The accord memory in diabetes mind study investigated whether persons randomized to an intensive glycaemic therapeutic strategy targeting hba 1c to 2008 guidance in diabetes care the good, the bad, the ugly, and the future 3.
Has carbohydraterestriction been forgotten as a treatment. The action to control cardiovascular disease in diabetes accord study has completed its full 5yr planned followup, and all main results have been published 14. In the accord trial, the group investigated if intensive blood glucose therapytargeting normal hba1c levelswould reduce cardiovascular events. Persistent effects of intensive glycemic control on retinopathy in type 2 diabetes in the action to control cardiovascular risk in diabetes accord followon study. The action to control cardiovascular risk in diabetes accord trial sought to explore whether more intensive glucose control regimens were associated with better outcomes in patients with type 2 diabetes mellitus. They also experience increased rates of nonfatal myocardial infarction and stroke. Accord lipid was a substudy of accord and employed 2x2 factorial design in about half of accord s participants. Treatment of diabetic dyslipidemia, comprised mainly of hypertriglyceridemia, and low hdlc, with either statin or fibrate monotherapy, is moderately effective at reversing the abnormal lipid levels, but does not completely reverse the risk of cvd. Accord stands for action to control cardiovascular risk in diabetes.
In 2008, the results of the glucose control study raised some eyebrows. Accord was a randomized cardiovascular clinical trial in 10,251 with type 2 diabetes who were treated and followed for an average of approximately 5 years from 2001 through mid2009. Dec 18, 2014 while these findings were unexpected and have raised some concerns about diabetes treatment strategies for specific groups of people, they should not trigger a change in therapy for most people with diabetes. Diabetes and cardiovascular risk management vivian fonseca, md, frcp disclosures honoraria for consulting and lectures. The action to control cardiovascular risk in diabetes accord study group. People with type 2 diabetes are at elevated risk for a number of serious health problems. The dietary recommendation for diabetes in a prominent internal medicine textbook from 1923 was 75% fat, 17% protein, 6% alcohol and only 2% carbohydrate. Diabetes is a chronic illness that requires continuing medical care and patient selfmanagement education to prevent acute complications and to reduce the risk of longterm complications. Est page 2 leadership of the accord clinical trial will make statements. This randomized control trial rct sets out to test if there is a correlation between a1c and.
Published in 2010, the action to control cardiovascular risk in diabetes accord lipid substudy evaluated addon fenofibrate therapy to simvastatin 2040 mg monotherapy among 5,518 adults with t2dm. In the accord bp trial, compared with combined standard treatment. Up to 10% of episodes of severe sulfonylureainduced hypoglycemia in type 2 diabetes may be fatal 17. The degree of benefit from a medical intervention is based on the absolute risk of vascular events, with patients at higher risk deriving greater benefit. Benefits and harms of intensive glycemic control in. The accord action to control cardiovascular risk in. Accord study group and accord eye study group, effects of medical therapies on retinopathy progression in type 2 diabetes. Effects of intensive glucose lowering in type 2 diabetes nejm. Landmark accord trial finds intensive blood pressure and. Does intensive therapy of type 2 diabetes help or harm. Patients with type 2 diabetes mellitus t2dm are at high risk of developing cardiovascular disease cvd.
Nineteen of the 41 excess deaths from cardiovascular causes in the study were attributed to unexpected or pre. In 2008, three shorterterm studies action to control cardiovascular risk in diabetes accord 34, action in diabetes and vascular disease. Intensive blood glucose control and vascular outcomes in. Monday, december 3, 2018 american diabetes association. Perspectives in diabetes the barrier of hypoglycemia in diabetes. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. Nov 26, 2017 current guidelines from the american diabetes association recommend people with type 2 diabetes discuss their blood glucose goals with their physicians, since intensive control may not be the best approach for everyone with type 2 diabetes. Accord diabetes trial intensive versus standard a1c targets. Data available for request include the accord main study data and the accordion ancillary study data. Clinical implications of the accord trial the journal of.
It is therefore now appropriate to take stock and consider the clinical implications of these results. Action to control cardiovascular risk in diabetes followon accordion eye study group and the action to control cardiovascular risk in diabetes followon accordion study group. While these findings were unexpected and have raised some concerns about diabetes treatment strategies for specific groups of people, they should not trigger a change in therapy for most people with diabetes. The accord study investigated whether intensive therapy to target normal glycated hemoglobin hba1c levels would reduce cardiovascular events in patients with type 2 diabetes who had either established cardiovascular disease or additional cardiovascular risk factors when compared to standard therapy hba1c between 7. Intensive glycemic control in the accord and advance trials. The purpose of this study was to determine if intensive glycemic control, multiple lipid management and intensive blood pressure control could prevent major cardiovascular events myocardial infarction, stroke or cardiovascular death in adults with type 2. Implications for patients with type 2 diabetes harlan m. The purpose of this study was to determine if intensive glycemic control, multiple lipid management and intensive blood pressure control could prevent major cardiovascular events myocardial infarction, stroke or cardiovascular death in adults with type 2 diabetes. Diabetes management can differ across the spectrum accord ing to where elderly patients live i. Type 2 diabetes is characterised by relative insulin deficiency caused by pancreatic. The accord study was really the first trial to prospectively test the value of glycemic levels below current targets. A third trial, action to control cardiovascular risk in diabetes accord, terminated its glycemic control study early because of the finding of increased mortality in participants randomized to a strategy of very intensive glycemic control with a target a 1c of 2008 letters. Read about the role of gastric bypass surgery in managing type 2 diabetes and obesity on page 8. Standards of medical care in diabetes2008 diabetes care.
In february 2008, the glycemic control study of accord was halted embedded blood pressure and lipid studies are ongoing on the recommendation of the studys data safety monitoring board due to the finding of an increased rate of mortality in the intensive arm compared with the standard arm 1. The primary microvascular outcome of the trial was tested with 2856 study participants in the accord eye study by measuring whether the progression of diabetic retinopathy could be prevented. Between 1980 and 2004, the global rise in obesity, sedentary lifestyles, and an ageing population have quadrupled the incidence and prevalence of type 2 diabetes. Accord trial should also be compared with the 10year followup of the approximately 10year united kingdom prospective diabetes study ukpds trial, which tested the effect of intensive glycemia management during the active phase of the trial in patients with newly diagnosed. Accord provides important evidence to help guide treatment recommendations for adults with type 2 diabetes who have had a heart attack or stroke or who are otherwise at especially high risk for cardiovascular disease, said susan b. First and foremost, the mean level of glycemic control achieved in the accord trial, i. Diabetes control and complications trial dcct21 among patients with type 1 diabetes and the united kingdom prospective diabetes study ukpds22 among patients with newly or recently diagnosed type 2 diabeteswhich showed reductions in the early manifestations of microvascular complications with intensive glycemic control. Accord action to control cardiovascular risk in diabetes. Ann bullock, md division of diabetes treatment and prevention indian health service. The recommended total daily energy intake was 1,795. Preterax and diamicron modifiedrelease controlled evaluation advance 35, veterans affairs diabetes trial vadt 36 reported the effects of two levels of glycaemic control on cardiovascular.
And in this trial there was a positive result with a 33% reduction in progression of retinopathy in patients who were. Accord action to control cardiovascular risk in diabetes was specifically designed to determine the effects of intensive treatment of blood glucose, and either blood pressure accord blood pressure or plasma lipids accord lipid, on atherosclerotic cardiovascular disease outcomes in patients with type 2 diabetes who were at high risk of. The accord randomized trial diabetes care american. A study investigating a monoclonal antibody to t cells, teplizumab, in preventing type 1. In the early 20 th century, before any medications were available for the treatment of diabetes mellitus, experts recommended dietary carbohydraterestriction 1, 2. A third trial, action to control cardiovascular risk in diabetes accord, terminated its glycemic control study early because of the finding of increased mortality in participants randomized to a strategy of very intensive glycemic control with a target a 1c of diabetes accord study group are listed in the appendix.
Guidance study 7,597 patients with type 2 diabetes. Action to control cardiovascular risk in diabetes accord. The national heart, lung, and blood institute has announced the early termination of one treatment arm of the ongoing action to control cardiovascular risk in diabetes accord trial because of an increased risk for death among patients assigned to intensive glucoselowering therapy press release, february 6, 2008. Management of cardiovascular disease in patients with. A large clinical study designed to determine whether intensively lowering blood glucose levels, intensively lowering blood pressure, or treating blood lipid levels could reduce the risk of heart attack, stroke, or death in people with type 2 diabetes. Perspectives in diabetes the barrier of hypoglycemia in.
Editorial from the new england journal of medicine intensive glycemic control in the accord and advance trials. Benefits and harms of intensive glycemic control in patients. Department of medicine and the irving institute for clinical and translational research, columbia university college of physicians and surgeons, new york, new york. The action to control cardiovascular risk in diabetes study group. People with type 2 diabetes are at elevated risk for a. Type 2 diabetes mellitus is a metabolic disease that is diagnosed on the basis of sustained hyperglycemia. Accord diabetes trial intensive versus standard a1c. Persons with type 2 diabetes t2d are at risk for cognitive impairment and brain atrophy. The accord trial was a large north american trial of intense versus standard glucoselowering therapy in people with established type 2 diabetes and additional risk factors for cardiovascular disease. The action to control cardiovascular risk in diabetes accord.
Prior to the accord trial, several randomized controlled trials had. Results of the accord blood sugar clinical trial were reported in 2008. In the action to control cardiovascular risk in diabetes accord trial. Guidance study 7,597 patients with type 2 diabetes gap exists between checking hba1c and achieving target hba1c 2008. The cause of these unexpected, excess deaths in the accord trial is of great interest.
245 1635 1143 1546 762 1142 430 1025 1575 102 1500 379 1466 1449 64 85 630 1210 1141 620 456 599 617 305 1568 574 864 1387 1570 956 1538 970 1357 1025 1179 917 248 154 1289 1321 873 43 619 1194