ACCORD: Outcomes mixed with intensive glucose-lowering therapy

ACCORD Study Group. N Engl J Med. 2011;364:818-828.

Among patients with type 2 diabetes and a high risk for CVD, intensive glucose-lowering therapy resulted in lower rates of nonfatal MI but higher rates of mortality at 5 years vs. standard therapy, according to new results from the ACCORD trial.

In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, patients (n=4,733; age, 40 to 79 years) were randomly assigned to receive intensive therapy targeting a glycated hemoglobin level of less than 6% or standard therapy targeting a level between 7 and 7.9%.

The researchers followed the effects of glycemic intervention for a mean of 3.5 years before terminating the intensive regimen due to a higher rate of mortality in the intensive-therapy arm. They then applied the approaches used in the standard control group (n=5,518) to those of the intensive glucose-lowering group to provide an additional 17 months of follow-up.

Before termination, there was no significant difference between groups regarding the composite primary outcome of nonfatal MI, nonfatal stroke or death from CV causes (P=.13). However, there were more deaths from any cause in the intensive arm (HR=1.21; 95% CI, 1.02-1.44), as well as lower rates of nonfatal MI (HR=0.79; 95% CI, 0.66-0.95), which persisted throughout the entire follow-up period.

“The higher risk of death from any cause and from CV causes in the intensive-therapy group means that a therapeutic approach that targets glycated hemoglobin levels below 6% cannot be generally recommended in this population,” the researchers wrote. “Thus, the results of the ACCORD trial suggest a lower limit for glycemic targets, achieved with the use of multiple combinations of currently available approaches.”

Previous CARDIOLOGY TODAY coverage of the ACCORD trial from ACC 2010 can be found here.

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