Nine-Year Effects of 3.7 Years of Intensive Glycemic Control on Cardiovascular Outcomes - PubMed (original) (raw)
Randomized Controlled Trial
Nine-Year Effects of 3.7 Years of Intensive Glycemic Control on Cardiovascular Outcomes
ACCORD Study Group. Diabetes Care. 2016 May.
Abstract
Objective: In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, ∼4 years of intensive versus standard glycemic control in participants with type 2 diabetes and other cardiovascular risk factors had a neutral effect on the composite cardiovascular outcome, increased cardiovascular and total mortality, and reduced nonfatal myocardial infarction. Effects of the intervention during prolonged follow-up were analyzed.
Research design and methods: All surviving ACCORD participants were invited to participate in the ACCORD Follow-on (ACCORDION) study, during which participants were treated according to their health care provider's judgment. Cardiovascular and other health-related outcomes were prospectively collected and analyzed using an intention-to-treat approach according to the group to which participants were originally allocated.
Results: A total of 8,601 people, representing 98% of those who did not suffer a primary outcome or death during the ACCORD trial, were monitored for a median of 8.8 years and a mean of 7.7 years from randomization. Intensive glucose lowering for a mean of 3.7 years had a neutral long-term effect on the primary composite outcome (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death), death from any cause, and an expanded composite outcome that included all-cause death. Moreover, the risk of cardiovascular mortality noted during the active phase (hazard ratio 1.49; 95% CI 1.19, 1.87; P < 0.0001) decreased (HR 1.20; 95% CI 1.03, 1.39; P = 0.02).
Conclusions: In high-risk people with type 2 diabetes monitored for 9 years, a mean of 3.7 years of intensive glycemic control had a neutral effect on death and nonfatal cardiovascular events but increased cardiovascular-related death.
Trial registration: ClinicalTrials.gov NCT00000620.
© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
Figures
Figure 1
Hazard of outcomes during ACCORD and ACCORD/ACCORDION. The event rates and hazard ratios (HRs, ●) with 95% CIs (horizontal lines) are shown for prespecified outcomes that occurred from randomization until the end of the ACCORD trial and until the end of prolonged follow-up comprising the ACCORD and ACCORDION phase. MI, myocardial infarction.
Figure 2
The Kaplan-Meier curves display the time to event for the primary outcome (A) and total mortality (B) during follow-up from randomization until the end of ACCORDION. The inset for each graph displays the same curve with a magnified _y_-axis. The numbers of individuals at risk are shown for each time point.
Figure 3
The Kaplan-Meier curves display the time to event for the three components of the primary outcome, including nonfatal myocardial infarction (MI) (A), nonfatal stroke (B), and cardiovascular (CV) death (C) during follow-up from randomization until the end of ACCORDION. The inset displays the same curve with a magnified _y_-axis. The numbers of individuals at risk are shown for each time point.
Similar articles
- Long-term effects of intensive glucose lowering on cardiovascular outcomes.
ACCORD Study Group; Gerstein HC, Miller ME, Genuth S, Ismail-Beigi F, Buse JB, Goff DC Jr, Probstfield JL, Cushman WC, Ginsberg HN, Bigger JT, Grimm RH Jr, Byington RP, Rosenberg YD, Friedewald WT. ACCORD Study Group, et al. N Engl J Med. 2011 Mar 3;364(9):818-28. doi: 10.1056/NEJMoa1006524. N Engl J Med. 2011. PMID: 21366473 Free PMC article. Clinical Trial. - Effects of Intensive Systolic Blood Pressure Lowering on Cardiovascular Events and Mortality in Patients With Type 2 Diabetes Mellitus on Standard Glycemic Control and in Those Without Diabetes Mellitus: Reconciling Results From ACCORD BP and SPRINT.
Beddhu S, Chertow GM, Greene T, Whelton PK, Ambrosius WT, Cheung AK, Cutler J, Fine L, Boucher R, Wei G, Zhang C, Kramer H, Bress AP, Kimmel PL, Oparil S, Lewis CE, Rahman M, Cushman WC. Beddhu S, et al. J Am Heart Assoc. 2018 Sep 18;7(18):e009326. doi: 10.1161/JAHA.118.009326. J Am Heart Assoc. 2018. PMID: 30371182 Free PMC article. Clinical Trial. - Long-Term Effects of Intensive Glycemic and Blood Pressure Control and Fenofibrate Use on Kidney Outcomes.
Mottl AK, Buse JB, Ismail-Beigi F, Sigal RJ, Pedley CF, Papademetriou V, Simmons DL, Katz L, Mychaleckyj JC, Craven TE. Mottl AK, et al. Clin J Am Soc Nephrol. 2018 Nov 7;13(11):1693-1702. doi: 10.2215/CJN.06200518. Epub 2018 Oct 25. Clin J Am Soc Nephrol. 2018. PMID: 30361335 Free PMC article. Clinical Trial. - Intensive glycemic control and cardiovascular disease: an update.
Brown A, Reynolds LR, Bruemmer D. Brown A, et al. Nat Rev Cardiol. 2010 Jul;7(7):369-75. doi: 10.1038/nrcardio.2010.35. Epub 2010 Apr 20. Nat Rev Cardiol. 2010. PMID: 20404853 Review. - Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials.
Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M, Lafont S, Bergeonneau C, Kassaï B, Erpeldinger S, Wright JM, Gueyffier F, Cornu C. Boussageon R, et al. BMJ. 2011 Jul 26;343:d4169. doi: 10.1136/bmj.d4169. BMJ. 2011. PMID: 21791495 Free PMC article. Review.
Cited by
- 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2024.
American Diabetes Association Professional Practice Committee. American Diabetes Association Professional Practice Committee. Diabetes Care. 2024 Jan 1;47(Suppl 1):S111-S125. doi: 10.2337/dc24-S006. Diabetes Care. 2024. PMID: 38078586 Review. - The legacy effect of hyperglycemia and early use of SGLT-2 inhibitors: a cohort study with newly-diagnosed people with type 2 diabetes.
Ceriello A, Lucisano G, Prattichizzo F, La Grotta R, Frigé C, De Cosmo S, Di Bartolo P, Di Cianni G, Fioretto P, Giorda CB, Pontremoli R, Russo G, Viazzi F, Nicolucci A; AMD Annals study group. Ceriello A, et al. Lancet Reg Health Eur. 2023 Jun 12;31:100666. doi: 10.1016/j.lanepe.2023.100666. eCollection 2023 Aug. Lancet Reg Health Eur. 2023. PMID: 37547276 Free PMC article. - Diabetic vascular diseases: molecular mechanisms and therapeutic strategies.
Li Y, Liu Y, Liu S, Gao M, Wang W, Chen K, Huang L, Liu Y. Li Y, et al. Signal Transduct Target Ther. 2023 Apr 10;8(1):152. doi: 10.1038/s41392-023-01400-z. Signal Transduct Target Ther. 2023. PMID: 37037849 Free PMC article. Review. - Effects of Vegetables Consumption Before Carbohydrates on Blood Glucose and GLP-1 Levels Among Diabetic Patients in Indonesia.
Indarto D, Rochmah DN, Wiboworini B, Pratama YM, Wibowo YC. Indarto D, et al. Int J Prev Med. 2022 Nov 23;13:144. doi: 10.4103/ijpvm.IJPVM_704_20. eCollection 2022. Int J Prev Med. 2022. PMID: 36618536 Free PMC article.
References
- Gerstein HC, Werstuck GH. Dysglycaemia, vasculopenia, and the chronic consequences of diabetes. Lancet Diabetes Endocrinol 2013;1:71–78 - PubMed
- ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J, et al. . Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560–2572 - PubMed
- Duckworth W, Abraira C, Moritz T, et al. .; VADT Investigators . Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009;360:129–139 - PubMed
- UK Prospective Diabetes Study (UKPDS) Group Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837–853 - PubMed
Publication types
MeSH terms
Substances
Grants and funding
- HHSN268201100027C/HL/NHLBI NIH HHS/United States
- N01HC95183/HC/NHLBI NIH HHS/United States
- Y01 HC001010/HC/NHLBI NIH HHS/United States
- N01HC95178/HC/NHLBI NIH HHS/United States
- Y01 HC009035/HC/NHLBI NIH HHS/United States
- N01HC95184/HC/NHLBI NIH HHS/United States
- N01HC95182/HC/NHLBI NIH HHS/United States
- N01HC95179/HC/NHLBI NIH HHS/United States
- N01HC95180/HC/NHLBI NIH HHS/United States
- N01HC95181/HC/NHLBI NIH HHS/United States
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical